Impact of patient global assessment on achieving remission in patients with rheumatoid arthritis: A multinational study using the METEOR database

Ferreira, Ricardo J. O.; Carvalho, Pedro David; Ndosi, Mwidimi; Duarte, C�tia; Chopra, Arvind; Murphy, Elizabeth; van der Heijde, D�sir�e; Machado, Pedro M.; da Silva, Jos� A. P.

Abstract

OBJECTIVE: There is an ongoing debate about excluding patient's global assessment (PtGA) from composite and Boolean-based definitions of rheumatoid arthritis (RA) remission. This study aimed at determining the influence of PtGA on RA disease states, exploring differences across countries, and understanding the association between PtGA, measures of disease impact (symptoms), and markers of disease activity (inflammation). METHODS: Cross-sectional data from the Measurement of Efficacy of Treatment in the Era of Outcome in Rheumatology international database were used. We calculated the proportion of patients failing American College of Rheumatology/European League Against Rheumatism Boolean-based remission (4-variable remission) solely due to PtGA (PtGA-near-remission) in the overall sample and in the most representative countries (i.e., those with >3,000 patients in the database). Multivariable linear regression models were used to identify the main determinants of PtGA, grouped in predominantly inflammatory impact factors (28 tender joint counts, 28 swollen joint counts, and C-reactive protein level) and disease impact factors (pain and function). RESULTS: This study included 27,768 patients. Excluding PtGA from the Boolean-based definition (3-variable remission) increased the remission rate from 5.8% to 15.8%. The rate of PtGA-near-remission varied considerably between countries, from 1.7% in India to 17.9% in Portugal. One-third of the patients in PtGA-near-remission group scored PtGA >4 of 10. Pain and function were the main correlates of PtGA, with inflammation-related variables contributing less to the model (R2 = 0.57). CONCLUSION: PtGA is moderately related to joint inflammation overall, but only weakly so in low levels of disease activity. A considerable proportion of patients otherwise in biologic remission still perceive high PtGA, putting them at risk of excessive immunosuppressive treatment.

• Journal Article Type: Article
• Acceptance Date: Feb 25, 2019
• Online Publication Date: Mar 1, 2019
• Publication Date: Oct 1, 2019
• Deposit Date: Mar 7, 2019
• Publicly Available Date: Mar 2, 2020
• Journal: Arthritis Care & Research
• Print ISSN: 2151-464X
• Electronic ISSN: 2151-4658
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 71
• Issue: 10
• Pages: 1317-1325
• DOI: https://doi.org/10.1002/acr.23866
• Keywords: arthritis, rheumatoid, disease activity, patient global assessment, patient reported outcomes, remission
• Public URL: https://uwe-repository.worktribe.com/output/851080
• Publisher URL: http://doi.org/10.1002/acr.23866
• Related Public URLs: https://www.ncbi.nlm.nih.gov/pubmed/30821895; https://doi.org/10.1002/acr.23866; https://onlinelibrary.wiley.com/doi/abs/10.1002/acr.23866
• Additional Information: Additional Information : This is the peer reviewed version of the following article: [Ferreira, R. J. O. , Carvalho, P. D. , Ndosi, M. , Duarte, Cátia, Chopra, A. , Murphy, E. , van der Heijde, Désirée, Machado, P. M. and da Silva, José A. P. (2019) Impact of patient global assessment on achieving remission in patients with rheumatoid arthritis: a multinational study using the METEOR database. Arthritis Care & Research. ISSN 2151-464X ], which has been published in final form at Ferreira, R. J. O. , Carvalho, P. D. , Ndosi, M. , Duarte, Cátia, Chopra, A. , Murphy, E. , van der Heijde, Désirée, Machado, P. M. and da Silva, José A. P. (2019) Impact of patient global assessment on achieving remission in patients with rheumatoid arthritis: a multinational study using the METEOR database. Arthritis Care & Research. ISSN 2151-464X. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.
• Contract Date: Mar 7, 2019