TY - JOUR
T1 - Patient perspective on remission in rheumatoid arthritis
T2 - Validation of patient reported outcome instruments to measure absence of disease activity
AU - Rasch, L.
AU - Boers, M.
AU - Lems, W.
AU - van Schaardenburg, D.
AU - Proudman, S.
AU - Hill, C. L.
AU - Duarte, C.
AU - Kuriya, B.
AU - Davis, B.
AU - Hoogland, W.
AU - Voshaar, M.
AU - van Tuyl, L.
N1 - Funding Information: We want to thank all members of the OMERACT Working Group on the Patient Perspective on Remission in RA for their valuable contribution to the work reported in this manuscript. Publisher Copyright: © 2021 The Authors
PY - 2021/12/1
Y1 - 2021/12/1
N2 - Objective: Patients have identified pain, fatigue and independence as the most important domains that need to be improved to define remission in rheumatoid arthritis (RA). This study identified and validated instruments for these domains and evaluated their added value to the ACR/EULAR Boolean remission definition. Methods: Patients with a 28-joint Disease Activity Score (DAS28) ≤3.2 or in self-perceived remission (declaring their disease activity ‘as good as gone’) from the Netherlands, Portugal, Australia, and Canada, were assessed at 0, 3 and 6 months for patient-reported outcomes and the WHO-ILAR RA core set. Instrument validity was evaluated cross-sectionally, longitudinally and for the ability to predict future good outcome in terms of physical functioning. Logistic regression quantified the added value to Boolean remission. Results: Of 246 patients, 152 were also assessed at 3, and 142 at 6 months. Most instruments demonstrated construct validity and discriminative capacity. Pain and fatigue were best captured by a simple numerical rating scale (NRS). Measurement of independence proved more complex, but a newly developed independence NRS was preferred. NRS for pain, fatigue and independence, in addition to or instead of patient global assessment did not add enough information to justify modification of the current Boolean definition of remission in RA. Conclusion: Key elements of the patient perspective on remission in RA can be captured by NRS pain, fatigue, and independence. Although this study did not find conclusive evidence to improve the current definition of remission in RA, the information from these instruments adds value to the physician's assessment of remission and further bridges the gap between physician and patient.
AB - Objective: Patients have identified pain, fatigue and independence as the most important domains that need to be improved to define remission in rheumatoid arthritis (RA). This study identified and validated instruments for these domains and evaluated their added value to the ACR/EULAR Boolean remission definition. Methods: Patients with a 28-joint Disease Activity Score (DAS28) ≤3.2 or in self-perceived remission (declaring their disease activity ‘as good as gone’) from the Netherlands, Portugal, Australia, and Canada, were assessed at 0, 3 and 6 months for patient-reported outcomes and the WHO-ILAR RA core set. Instrument validity was evaluated cross-sectionally, longitudinally and for the ability to predict future good outcome in terms of physical functioning. Logistic regression quantified the added value to Boolean remission. Results: Of 246 patients, 152 were also assessed at 3, and 142 at 6 months. Most instruments demonstrated construct validity and discriminative capacity. Pain and fatigue were best captured by a simple numerical rating scale (NRS). Measurement of independence proved more complex, but a newly developed independence NRS was preferred. NRS for pain, fatigue and independence, in addition to or instead of patient global assessment did not add enough information to justify modification of the current Boolean definition of remission in RA. Conclusion: Key elements of the patient perspective on remission in RA can be captured by NRS pain, fatigue, and independence. Although this study did not find conclusive evidence to improve the current definition of remission in RA, the information from these instruments adds value to the physician's assessment of remission and further bridges the gap between physician and patient.
KW - OMERACT
KW - Patient perspective
KW - Patient reported outcomes
KW - Remission
KW - Rheumatoid arthritis
UR - http://www.scopus.com/inward/record.url?scp=85120973994&partnerID=8YFLogxK
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85120973994&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/34538513
U2 - https://doi.org/10.1016/j.semarthrit.2021.07.005
DO - https://doi.org/10.1016/j.semarthrit.2021.07.005
M3 - Article
C2 - 34538513
SN - 0049-0172
VL - 51
SP - 1360
EP - 1369
JO - Seminars in Arthritis and Rheumatism
JF - Seminars in Arthritis and Rheumatism
IS - 6
ER -