Back to Basics: Prioritizing Communication as a Key Instrument in Managing Rheumatoid Arthritis

Studenic, Paul; Radner, Helga

doi:10.3899/jrheum.210984

Cited by 3 publications

(3 citation statements)

References 32 publications

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“…Studies have shown that a treat-to-target approach is not yet fully implemented in clinical practice; in one-third of instances where treatment was not increased, this was influenced by factors unrelated to RA and in another third it was the patient’s preference to continue receiving the current treatment 38 39. All measurements and their interpretations need, in any case, to be complemented by the discussion between the patient and rheumatology clinician to reflect and decide on the appropriate steps in a shared decision 40 41…”

Section: Discussionmentioning

confidence: 99%

American College of Rheumatology/EULAR remission criteria for rheumatoid arthritis: 2022 revision

et al. 2022

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ObjectiveIn 2011, the American College of Rheumatology (ACR) and EULAR endorsed provisional criteria for remission in rheumatoid arthritis (RA), both Boolean-based and index-based. Based on recent studies indicating that a higher threshold for the patient global assessment (PtGA) may improve agreement between the two sets of criteria, our goals were to externally validate a revision of the Boolean remission criteria using a higher PtGA threshold and to validate the provisionally endorsed index-based criteria.MethodsWe used data from four randomised trials comparing biological disease-modifying antirheumatic drugs to methotrexate or placebo. We tested the higher proposed PtGA threshold of 2 cm (Boolean2.0) (range 0–10 cm) compared with the original threshold of 1 cm (Boolean1.0). We analysed agreement between the Boolean-based and index-based criteria (Simplified Disease Activity Index (SDAI) and Clinical Disease Activity Index (CDAI)) for remission and examined how well each remission definition predicted later good physical function (Health Assessment Questionnaire (HAQ) score≤0.5) and radiographic non-progression.ResultsData from 2048 trial participants, 1101 with early RA and 947 with established RA, were included. The proportion of patients with disease in remission at 6 months after treatment initiation increased when using Boolean2.0 compared with Boolean1.0, from 14.8% to 20.6% in early RA and 4.2% to 6.0% in established RA. Agreement between Boolean2.0 and the SDAI or CDAI remission criteria was better than for Boolean1.0, particularly in early disease. Boolean2.0, SDAI, and CDAI remission criteria had similar positive likelihood ratios (LRs) to predict radiographic nonprogression and a HAQ score of ≤0.5 (positive LR 3.8–4.3). The omission of PtGA (BooleanX) worsened the prediction of good functional outcomes.ConclusionUsing the Boolean 2.0 criteria classifies, more patients as achieving remission and increases the agreement with index-based remission criteria without jeopardising predictive value for radiographic or functional outcomes. This revised Boolean definition and the previously provisionally endorsed index-based criteria were endorsed by ACR and EULAR.

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Section: Discussionmentioning

confidence: 99%

American College of Rheumatology/EULAR remission criteria for rheumatoid arthritis: 2022 revision

et al. 2022

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“…Studies have shown that a treat‐to‐target approach is not yet fully implemented in clinical practice; in one‐third of instances where treatment was not increased, this was influenced by factors unrelated to RA and in another third it was the patient's preference to continue receiving the current treatment ( 38 , 39 ). All measurements and their interpretations need, in any case, to be complemented by the discussion between the patient and rheumatology clinician to reflect and decide on the appropriate steps in a shared decision ( 40 , 41 ).…”

Section: Discussionmentioning

confidence: 99%

American College of Rheumatology/EULAR Remission Criteria for Rheumatoid Arthritis: 2022 Revision

Studenic

Aletaha

Wit

et al. 2022

Arthritis & Rheumatology

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Objective In 2011, the American College of Rheumatology (ACR) and EULAR endorsed provisional criteria for remission in rheumatoid arthritis (RA), both Boolean‐ and index‐based. Based on recent studies indicating that a higher threshold for the patient global assessment (PtGA) may improve agreement between the 2 sets of criteria, our goals were to externally validate a revision of the Boolean remission criteria using a higher PtGA threshold and to validate the provisionally endorsed index‐based criteria. Methods We used data from 4 randomized trials comparing biologic disease‐modifying antirheumatic drugs to methotrexate or placebo. We tested the higher proposed PtGA threshold of 2 cm (Boolean2.0) (range 0–10 cm) compared to the original threshold of 1 cm (Boolean1.0). We analyzed agreement between the Boolean‐ and index‐based criteria (Simplified Disease Activity Index [SDAI] and Clinical Disease Activity Index [CDAI]) for remission and examined how well each remission definition predicted later good physical function (Health Assessment Questionnaire [HAQ] score ≤0.5) and radiographic nonprogression. Results Data from 2,048 trial participants, 1,101 with early RA and 947 with established RA, were included. The proportion of patients with disease in remission at 6 months after treatment initiation increased when using Boolean2.0 compared to Boolean1.0, from 14.8% to 20.6% in early RA and 4.2% to 6.0% in established RA. Agreement between Boolean2.0 and the SDAI or CDAI remission criteria was better than for Boolean1.0, particularly in early disease. Boolean2.0, SDAI, and CDAI remission criteria had similar positive likelihood ratios (LRs) to predict radiographic nonprogression and a HAQ score of ≤0.5 (positive LR 3.8–4.3). The omission of PtGA (BooleanX) worsened the prediction of good functional outcomes. Conclusion Using the Boolean 2.0 criteria classifies more patients as achieving remission and increases the agreement with index‐based remission criteria without jeopardizing predictive value for radiographic or functional outcomes. This revised Boolean definition and the previously provisionally endorsed index‐based criteria were endorsed by ACR and EULAR.

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“…We would need to design our care of patients more tailored to the patients’ needs, taking the socioeconomic background and multimorbidity into account. 17 – 19 To many health care professionals, this call for tailored treatment is no longer novel and there is lack of supporting infrastructure that might facilitate an integrative patient-driven care process. The dilemma behind these unmet needs is unfortunately further intensified by impeding structural changes awaiting patients and health care facilities.…”

Section: Introductionmentioning

confidence: 99%

Big data analyses and individual health profiling in the arena of rheumatic and musculoskeletal diseases (RMDs)

Cock

Myasoedova

Aletaha

et al. 2022

Therapeutic Advances in Musculoskeletal

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Health care processes are under constant development and will need to embrace advances in technology and health science aiming to provide optimal care. Considering the perspective of increasing treatment options for people with rheumatic and musculoskeletal diseases, but in many cases not reaching all treatment targets that matter to patients, care systems bare potential to improve on a holistic level. This review provides an overview of systems and technologies under evaluation over the past years that show potential to impact diagnosis and treatment of rheumatic diseases in about 10 years from now. We summarize initiatives and studies from the field of electronic health records, biobanking, remote monitoring, and artificial intelligence. The combination and implementation of these opportunities in daily clinical care will be key for a new era in care of our patients. This aims to inform rheumatologists and healthcare providers concerned with chronic inflammatory musculoskeletal conditions about current important and promising developments in science that might substantially impact the management processes of rheumatic diseases in the 2030s.

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Back to Basics: Prioritizing Communication as a Key Instrument in Managing Rheumatoid Arthritis

Cited by 3 publications

References 32 publications

American College of Rheumatology/EULAR remission criteria for rheumatoid arthritis: 2022 revision

American College of Rheumatology/EULAR remission criteria for rheumatoid arthritis: 2022 revision

American College of Rheumatology/EULAR Remission Criteria for Rheumatoid Arthritis: 2022 Revision

Big data analyses and individual health profiling in the arena of rheumatic and musculoskeletal diseases (RMDs)

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