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Rodwell N, Hassett G, Bird P, Pincus T, Descallar J, Gibson KA. RheuMetric Quantitative 0 to 10 Physician Estimates of Inflammation, Damage, and Distress in Rheumatoid Arthritis: Validation Against Reference Measures. ACR Open Rheumatol 2023; 5:511-521. [PMID: 37608509 PMCID: PMC10570671 DOI: 10.1002/acr2.11574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/23/2023] [Accepted: 04/26/2023] [Indexed: 08/24/2023] Open
Abstract
OBJECTIVE To analyze a RheuMetric checklist, which includes four feasible physician 0 to 10 scores for DOCGL, inflammation (DOCINF), damage (DOCDAM), and distress (DOCSTR) for criterion and discriminant validity against standard reference measures. METHODS A prospective, cross-sectional assessment was performed at one routine care visit at Liverpool Hospital, Sydney, Australia. Rheumatologists recorded DOCGL, DOCINF, DOCDAM, DOCSTR, and 28 joint counts for swelling (SJC), tenderness (TJC), and limited motion/deformity (DJC). Patients completed a multidimensional health assessment questionnaire (MDHAQ), which includes routine assessment of patient index data (RAPID3), fibromyalgia assessment screening tool (FAST4), and MDHAQ depression screen (MDS2). Laboratory tests and radiographic scores were recorded. RheuMetric estimates of inflammation, damage, and distress were compared with reference and other measures using correlations and linear regressions. RESULTS In 173 patients with RA, variation in RheuMetric DOCINF was explained significantly by SJC and inversely by disease duration; variation in DOCDAM was explained significantly by DJC, radiographic scores, and physical function; and variation in DOCSTR was explained significantly by fibromyalgia and depression. CONCLUSION RheuMetric DOCINF, DOCDAM, and DOCSTR estimates were correlated significantly and specifically with reference measures of inflammation, damage, and distress, documenting criterion and discriminant validity.
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Affiliation(s)
- Nicholas Rodwell
- Liverpool Hospital and Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia, and University of New South WalesMedicine and HealthSydneyNew South WalesAustralia
| | - Geraldine Hassett
- Liverpool Hospital and Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia, and University of New South WalesMedicine and HealthSydneyNew South WalesAustralia
| | - Paul Bird
- University of New South Wales, Medicine and HealthKensingtonSydneyNew South WalesAustralia
| | | | - Joseph Descallar
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia, and University of New South WalesMedicine and HealthSydneyNew South WalesAustralia
| | - Kathryn A. Gibson
- Liverpool Hospital and Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia, and University of New South WalesMedicine and HealthSydneyNew South WalesAustralia
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Schmukler J, Li T, Gibson KA, Morla RM, Luta G, Pincus T. Patient global assessment is elevated by up to 5 of 10 units in patients with inflammatory arthritis who screen positive for fibromyalgia (by FAST4) and/or depression (by MDS2) on a single MDHAQ. Semin Arthritis Rheum 2023; 58:152151. [PMID: 36586208 DOI: 10.1016/j.semarthrit.2022.152151] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 12/01/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Patient global assessment (PATGL) is a component of rheumatoid arthritis (RA) and spondyloarthritis (SpA) activity indices, reflecting inflammation in selected clinical trial patients. In routine care, PATGL often may be elevated independently of inflammatory activity by fibromyalgia (FM) and/or depression, leading to complexities in interpretation. A feasible method to screen for FM and/or depression could help to clarify interpretation of high PATGL and index scores, including explanation of apparent limited responses to anti-inflammatory therapies. PATIENTS AND METHODS Patients with RA or SpA in routine care in Barcelona, Chicago, and Sydney complete a 2-page multidimensional health assessment questionnaire (MDHAQ) in 5-10 min. The MDHAQ includes PATGL and three indices, RAPID3 (routine assessment of patient index data) to assess clinical status, FAST4 (0-4 fibromyalgia assessment screening tool) and MDS2 (0-2 MDHAQ depression screen). PATGL was compared for each diagnosis at each site and pooled data in FAST4 positive (+) vs negative (-) and/or MDS2+ vs MDS2- patients using medians and median regressions. RESULTS Median PATGL was 5.0 in 393 RA and 175 SpA patients; 2.0-3.0 in 305 (58.9%) FAST4-,MDS2- patients, 5.5-6.0 in 71 (13.7%) FAST4-,MDS2+ patients, 7.0-7.5 in 50 (9.7%) FAST4+,MDS2- patients, and 7.0-8.0 in 92 (17.8%) FAST4+,MDS2+ patients. Positive FAST4 and/or MDS2 screens were seen in 41% of patients. Results were similar in RA and SpA at 3 settings on 3 continents. CONCLUSION Median 0-10 PATGL varied from 2-3/10 to 5.5-8/10, according to negative vs positive screening for FM and/or depression on a single MDHAQ for busy clinical settings.
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Affiliation(s)
- Juan Schmukler
- Division of Rheumatology, Department of Medicine, Rush University School of Medicine, Chicago, IL 60612, United States
| | - Tengfei Li
- Department of Biostatistics, Bioinformatics & Biomathematics, Georgetown University, Washington, DC 20057, United States
| | - Kathryn A Gibson
- Department of Rheumatology, Liverpool Hospital, Ingham Research Institute, University of New South Wales, Sydney, NSW 2170, Australia
| | - Rosa M Morla
- Department of Rheumatology, Hospital Clinic Universitari de Barcelona, Institut d´investigacions Biomèdiques August Pi i Sunyer, 08036 Barcelona, Spain
| | - George Luta
- Department of Biostatistics, Bioinformatics & Biomathematics, Georgetown University, Washington, DC 20057, United States
| | - Theodore Pincus
- Division of Rheumatology, Department of Medicine, Rush University School of Medicine, Chicago, IL 60612, United States.
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A systematic comparison of different composite measures (DAS 28, CDAI, SDAI, and Boolean approach) for determining treatment effects on low disease activity and remission in rheumatoid arthritis. BMC Rheumatol 2022; 6:82. [PMID: 36482451 PMCID: PMC9732992 DOI: 10.1186/s41927-022-00314-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 10/07/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Some composite measures for determining the treatment effects of disease-modifying antirheumatic drugs on remission and low disease activity (LDA) in rheumatoid arthritis (RA) may produce misleading results if they include an acute phase reactant (APR). To inform the choice of appropriate measure, we performed a systematic comparison of treatment effects using different composite measures. METHODS We used data generated for a systematic review of biologics in RA conducted by the Institute for Quality and Efficiency in Health Care and data from systematic reviews of newer biologics and Janus kinase (JAK) inhibitors provided by sponsors. The studies included had been conducted up to 2020 and investigated comparisons of biologics with placebo and head-to-head comparisons of biologics. Treatment effects on LDA and remission in studies investigating biologics or JAK inhibitors in RA were compared among 4 composite measures: the disease activity score 28 (DAS 28), the simplified disease activity index (SDAI), the Boolean approach (remission only), and the clinical disease activity index (CDAI)-only the latter does not include an APR. RESULTS 49 placebo-controlled studies included 9 different biologics; 48 studies (16,233 patients) investigated LDA and 49 (16,338 patients) investigated remission. 11 active-controlled studies (5996 patients) investigated both LDA and remission and included 5 different head-to-head comparisons of biologics and 5 different comparisons (6 studies) of biologics with JAK inhibitors. Statistically significantly larger treatment effects were found for biologics or JAK inhibitors versus placebo or active control in 16% of pairwise comparisons of composite measures (27 of 168). Most of these larger effects were observed for composite measures with an APR, i.e. the DAS 28 (19 comparisons) followed by the SDAI (n = 7). Larger effects were most frequently detected in favour of interleukin (IL)-6 inhibitors and to a lesser extent for JAK inhibitors versus treatments with different modes of action. CONCLUSIONS The use of the DAS 28 and SDAI in clinical studies may generate results favouring certain treatments based on their mode of action (e.g. IL-6 inhibitors versus other biologics). To enable unbiased comparative effectiveness research, a composite measure without an APR (i.e. the CDAI) should thus be the measure of choice.
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Bugatti S, De Stefano L, D'Onofrio B, Nicrosini A, Mauric E, di Lernia M, Sakellariou G, Favalli EG, Manzo A, Caporali R, Montecucco C. Inflammatory correlates of the Patient Global Assessment of Disease Activity vary in relation to disease duration and autoantibody status in patients with rheumatoid arthritis. Ann Rheum Dis 2022; 81:1206-1213. [PMID: 35623639 DOI: 10.1136/annrheumdis-2022-222436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/16/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate the associations between the Patient Global Assessment (PGA) and measures of disease activity in patients with rheumatoid arthritis (RA) in relation to disease duration and autoantibody status. METHODS 1412 patients from three independent cohorts were studied: a prospective cohort of 810 patients with early RA followed up for 24 months; a cross-sectional cohort of 210 patients with established RA in low disease activity; a cross-sectional cohort of 401 patients with established RA in moderate-to-high disease activity. Correlations of the PGA were analysed by Pearson's coefficients and multivariable linear regression at baseline and at months 6, 12 and 24 in the overall populations and after stratification for autoantibody subgroup and remission status (Boolean remission, PGA near remission and non-remission). RESULTS In patients with early RA in non-remission, swollen joints correlated independently with the PGA; the correlation became progressively weaker but persisted at all time points in autoantibody-positive patients (adjusted r=0.30-0.12) but lost significance after month 12 in autoantibody-negative patients. Swollen joints independently correlated with the PGA also in near remission until month 12 (adjusted r=0.18-0.16) in autoantibody-positive patients. No independent correlations of inflammatory variables were instead found in patients with established RA irrespective of disease activity and autoantibody status. CONCLUSIONS In the early phases of RA, particularly in autoantibody-positive patients, inflammatory variables directly correlate with the PGA across different disease activity states. The optimal cut-off values of the PGA capable of identifying absence of disease should be better explored in relation to disease duration and autoantibody status.
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Affiliation(s)
- Serena Bugatti
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
| | - Ludovico De Stefano
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
| | - Bernardo D'Onofrio
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
| | - Andrea Nicrosini
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
| | - Eleonora Mauric
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
| | - Michele di Lernia
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
| | - Garifallia Sakellariou
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
- Maugeri Clinical Research Institutes IRCCS Pavia, Pavia, Italy
| | - Ennio Giulio Favalli
- Department of Rheumatology, Gaetano Pini-CTO, Milano, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
| | - Antonio Manzo
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
| | - Roberto Caporali
- Department of Rheumatology, Gaetano Pini-CTO, Milano, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
| | - Carlomaurizio Montecucco
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
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Smolen JS. Greetings from the editor. Ann Rheum Dis 2022. [PMID: 35577363 DOI: 10.1136/annrheumdis-2022-222621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Josef S Smolen
- Rheumatology, Medical University of Vienna, Vienna, Austria
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Ferreira RJO, Welsing PMJ, Jacobs JW, Gossec L, Ndosi M, Machado PM, van der Heijde D, Da Silva JA. Correspondence on 'Re-examining remission definitions in rheumatoid arthritis: considering the 28-joint Disease Activity Score, C reactive protein level and patient global assessment' by Felson et al. Ann Rheum Dis 2022:annrheumdis-2021-221917. [PMID: 35177410 DOI: 10.1136/annrheumdis-2021-221917] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 11/28/2021] [Indexed: 01/23/2023]
Affiliation(s)
- Ricardo J O Ferreira
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Coimbra, Portugal.,Health Sciences Research Unit: Nursing (UICISA: E), Higher School of Nursing of Coimbra, Coimbra, Coimbra, Portugal
| | - Paco M J Welsing
- Department of Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht, Utrecht, The Netherlands
| | - Johannes Wg Jacobs
- Rheumatology and Clinical Immunology F02.127, UMC Utrecht, Utrecht, The Netherlands
| | - Laure Gossec
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Universite, Paris, France.,APHP, Rheumatology Department, Hopital Universitaire Pitie Salpetriere, Paris, France
| | - Mwidimi Ndosi
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Pedro M Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK.,Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Désirée van der Heijde
- Rheumatology Department, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Jose Ap Da Silva
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Coimbra, Portugal .,Clínica Universitária de Reumatologia and i-CBR Coimbra Institute for Clinical and Biological Research, Faculty of Medicine, University of Coimbra, Coimbra, Coimbra, Portugal
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