Discordance between tender and swollen joint count as well as patient's and evaluator's global assessment may reduce likelihood of remission in patients with rheumatoid arthritis and psoriatic arthritis: data from the prospective multicentre NOR-DMARD study

Michelsen, Brigitte; Kristianslund, Eirik; Hammer, Hilde Berner; Fagerli, K.; Lie, Elisabeth; Wierød, Ada; Kalstad, Synøve; Rødevand, Erik; Krøll, Frode; Haugeberg, Glenn; Kvien, Tore K

doi:10.1136/annrheumdis-2016-210283

Cited by 54 publications

(52 citation statements)

References 22 publications

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“…We have recently reported reduced likelihood of remission among RA and PsA patients with discordance between baseline patient’s and evaluator’s global assessment as well as tender and swollen joint count 18. Discordance between more subjectively and more objectively weighted measures of disease activity may be reflected by psychosocial factors like depression 4…”

Section: Discussionmentioning

confidence: 99%

Do depression and anxiety reduce the likelihood of remission in rheumatoid arthritis and psoriatic arthritis? Data from the prospective multicentre NOR-DMARD study

et al. 2017

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Section: Discussionmentioning

confidence: 99%

Do depression and anxiety reduce the likelihood of remission in rheumatoid arthritis and psoriatic arthritis? Data from the prospective multicentre NOR-DMARD study

et al. 2017

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“…Discordance between physicians’ and patients’ perspectives may have important clinical implications. The discordance between change in active joint count by physicians and change in PGA was found to be a negative predictor of achieving remission, which is the target of treatment in clinical practice . In rheumatoid arthritis, discordance was also reported to be associated with reduction in work productivity .…”

Section: Discussionmentioning

confidence: 94%

Factors associated with patient‐physician discordance in a prospective cohort of patients with psoriatic arthritis: An Asian perspective

et al. 2019

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Objectives To evaluate factors associated with patient‐physician discordance in a multiethnic Asian cohort of psoriatic arthritis (PsA) patients. Methods We used data from a prospective cohort of consecutive patients with PsA fulfilling the Classification Criteria for Psoriatic Arthritis, recruited from a single center in Singapore. Sociodemographic, clinical data and patient‐reported outcomes were collected using a standardized protocol at baseline, 4 months, 8 months, 1 year, 2 years and 5 years. patient‐physician discordance was defined as patient global assessment minus physician global assessment (PGA‐PhGA). We evaluated variables associated with patient‐physician discordance using generalized linear regression to control for within‐subject effect. Results One hundred and fortytwo patients (51.4% male, 66.2% Chinese, mean [SD] age and duration of illness 51.1 [13.8] years and 27.5 [98.3] months) were recruited at baseline. Paired results for PGA and PhGA were available for 291 visits with median (interquartile range) follow‐up time of 11.6 (17) months. In univariable analysis, duration of illness, fatigue, pain, tender and swollen joint count, dactylitis count, and health‐related quality of life (Short Form‐36) domains were significantly correlated with patient‐physician discordance. In multivariable analysis, age, fatigue level, pain score were positively associated with patient‐physician discordance, while swollen joint count and mental health were negatively associated with patient physician discordance. Conclusions Increased age, higher fatigue levels, higher pain score and poorer mental health may explain underestimation of disease activity by physicians. Physicians’ overestimation of disease activity may be explained by higher swollen joint counts.

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“…New ACR/EULAR de nitions are more stringent and fewer patients are classi ed as being in remission using these concepts. Accordingly, barely half of patients with DAS28-ESR < 2.6 ful lled SDAI or ACR/EULAR Boolean remission criteria in clinical practice [14]. However, whether or not more stringent remission criteria provide better clinical and radiographic outcomes in the long term is still under debate.…”

Section: Discussionmentioning

confidence: 99%

Comparable Clinical and Radiographic Outcomes among DAS28-ESR-based Remission Criteria and SDAI, CDAI, and ACR/EULAR Boolean definitions in patients with Established Rheumatoid Arthritis in Clinical Practice. Observational Study of 5 years of Follow-Up

Ramírez¹,

Inciarte-Mundo²,

Cuervo³

et al. 2020

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Objective To compare long-term clinical and radiographic outcomes among five sets of remission criteria [four clinical and one Ultrasound (US)-based] in a cohort of RA patients in a clinical care setting. Methods RA patients in remission (DAS28-ESR <2.6) were selected. Hand US assessments were performed, and serum levels of inflammation/angiogenesis biomarkers were determined at baseline. Changes in baseline treatment and radiographic progression, defined as the variation in the modified Sharp van der Heijde score (mSHS) at 5 years, were analyzed. To define remission, five different concepts were used, as follows: DAS28-ESR<2.6, SDAI<3.3, CDAI<2.8, Boolean criteria and score Power Doppler (PD)=0.Results Eighty-seven patients with DAS28-ESR<2.6 were included. One third fulfilled SDAI (33.3%), CDAI (31%) and Boolean (35.6%) remission criteria and 25.3% had no PD signal in the US evaluation. 26 patients (29.9%) changed the therapy, ranging from 13.6% (PD remission) to 33.3% (CDAI remission) (p=0.11). Serum levels of ANG (p=0.015) and TNFa (p=0.025) were significantly lower in patients with Boolean remission, whereas IL-18 levels were significantly lower in those with PD remission (p=0.049). Patients without PD in the US assessment had significantly lower mSHS erosion progression (p=0.014) at 5 years. Conclusions Patients with established RA in DAS28-ESR remission had comparable clinical and radiographic outcomes than SDAI, CDAI and Boolean definitions in a clinical care setting. US remission remained as the closest to structural damage abrogation.

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Discordance between tender and swollen joint count as well as patient's and evaluator's global assessment may reduce likelihood of remission in patients with rheumatoid arthritis and psoriatic arthritis: data from the prospective multicentre NOR-DMARD study

Abstract: Discordance between patient's and physician's evaluation of disease activity reflected through ΔTSJ and partly ΔPEG may reduce likelihood of remission in RA and PsA. The findings are relevant for use of the treat-to-target strategy in individual patients.

Cited by 54 publications

References 22 publications

Do depression and anxiety reduce the likelihood of remission in rheumatoid arthritis and psoriatic arthritis? Data from the prospective multicentre NOR-DMARD study

Do depression and anxiety reduce the likelihood of remission in rheumatoid arthritis and psoriatic arthritis? Data from the prospective multicentre NOR-DMARD study

Factors associated with patient‐physician discordance in a prospective cohort of patients with psoriatic arthritis: An Asian perspective

Comparable Clinical and Radiographic Outcomes among DAS28-ESR-based Remission Criteria and SDAI, CDAI, and ACR/EULAR Boolean definitions in patients with Established Rheumatoid Arthritis in Clinical Practice. Observational Study of 5 years of Follow-Up

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