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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.

Authors

Ricardo J. O. Ferreira

Pedro David Carvalho

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Dr Mwidimi Ndosi Mwidimi.Ndosi@uwe.ac.uk
Associate Professor in Nursing Rheumatology

C�tia Duarte

Arvind Chopra

Elizabeth Murphy

D�sir�e van der Heijde

Pedro M. Machado

Jos� A. P. da Silva



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.

Citation

Ferreira, R. J. O., Carvalho, P. D., Ndosi, M., Duarte, C., Chopra, A., Murphy, E., …da Silva, J. 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 and Research, 71(10), 1317-1325. https://doi.org/10.1002/acr.23866

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.

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