Perception of improvement in patients with rheumatoid arthritis varies with disease activity levels at baseline

Abstract

Objective. To analyze the minimum clinically important improvement (MCII) of disease activity measures in rheumatoid arthritis (RA) using patient-derived anchors, and to assess whether criteria for improvement differ with baseline disease activity. Methods. We used data from a Norwegian observational database comprising 1,050 patients (73% women, 65% rheumatoid factor-positive, mean duration of RA 7.7 years). At 3 months after initiation of therapy, patients indicated whether their condition had improved, had considerably improved, was unchanged, had worsened, or had considerably worsened. We used receiver operating characteristic curve analysis to determine the MCII for the Disease Activity Score based on the assessment of 28 joints (DAS28), the Simplified Disease Activity Index (SDAI), and the Clinical Disease Activity Index (CDAI), and analyzed the effects of different levels of baseline disease activity on the MCII. Results. On average, patients started with high disease activity and improved significantly during treatment (American College of Rheumatology 20%, 50%, and 70% improvement criteria responses were 37%, 17%, and 5%, respectively). The overall mean (95% confidence interval [95% CI]) thresholds for MCII after 3 months for the DAS28, SDAI, and CDAI were 1.20 (95% CI 1.18 -1.22), 10.95 (95% CI 10.69 -11.20), and 10.76 (95% CI 10.49 -11.04), respectively, and the mean (95% CI) thresholds for major responses were 1.82 (95% CI 1.80 -1.83), 15.82 (95% CI 15.65-16.00), and 15.00 (95% CI 14.82-15.18), respectively. With increasing disease activity, much higher changes in disease activity were needed to achieve MCII according to patient judgment. Conclusion. The perception of improvement of disease activity of patients with RA is considerably different depending on the disease activity level at which they start.

Optimisation of a treat-to-target approach in rheumatoid arthritis: strategies for the 3-month time point

“…This concept of the importance of a state rather than response has been propagated also by studies in the past looking at functional and structural outcomes, as well as the patient perspective 18 19…”

Validation of OMERACT preliminary rheumatoid arthritis flare domains in the NOR-DMARD study

“…Follow-up has been based on DMARD courses, and a switch or addition of DMARDs would lead to a new follow-up course. Data collection in all patients include diagnosis, demographics, medication, comorbidities, adverse events, employment, use of healthcare, 28-swollen joint counts and 28-tender joint counts (28-SJC and 28-TJC, respectively), erythrocyte sedimentation rate (ESR) in mm/first hour, C-reactive protein (CRP) in mg/L, 100 mm visual analogue scales (VAS) for physician's and patient's global assessment of disease activity as well as for joint pain and fatigue, the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36),14 the Modified Health Assessment Questionnaire (MHAQ),15 a question about acceptable state at each visit, a transition question about change in disease activity since start of current DMARD treatment (see next paragraph),16 and from 2006 onwards the EQ-5D (EuroQoL),17 the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)18 and Bath Ankylosing Spondylitis Functional Index19 questionnaires, completed by all patients. The disease activity score based on 28-joint counts (DAS28) was calculated with ESR.…”

Consenso da Sociedade Brasileira de Reumatologia 2011 para o diagnóstico e avaliação inicial da artrite reumatoide

“…Tables 5, 6, and 7 show how to calculate and use such indices. [82][83][84][85][86][87][88][89][90][91] There is a good correlation between these combined disease activity indices (CDAI, SDAI and DAS28), and any of them can be used in isolation. Patients undergoing remission or low disease activity, according to any of these indices, also have slower radiographic progression, and better functional evolution.…”