What Does the Patient Global Health Assessment in Rheumatoid Arthritis Really Tell Us? Contribution of Specific Dimensions of Health‐Related Quality of Life

Abstract

Objective. To estimate the contributions of health-related quality of life domains to the patient global assessment of health (PtGA) in rheumatoid arthritis (RA). Methods. Data are drawn from baseline visits of 2 observational RA cohorts. Participants completed patientreported outcome measures, including PtGA and Patient-Reported Outcomes Measurement Information System measures, and clinical data were collected. Factor analysis was used to identify latent variables, and multivariable linear regression was used to estimate determinants of the PtGA. Results. Patients were mostly female (81%), white (78%), and had established disease (mean ± SD 12.3 ± 10.7 years), with 62% in remission or having low disease activity. In cohort 1 (n = 196), the following 2 factors emerged: 1) daily function (moderate-to-strong [i.e., >|0.65|] loadings of physical function, pain interference, social participation, and fatigue, and weak [>0.35] loadings of sleep disturbance); and 2) emotional distress (strong loadings of depression and anxiety). In crude analysis, daily function explained up to 53% and emotional distress up to 20% of the variance in PtGA. In both cohorts, in adjusted analyses, daily function and, to a much lesser extent, swollen joint count independently predicted PtGA; age was inversely related to PtGA in cohort 1 only. Conclusion. These findings suggest that in patients with RA, PtGA ratings largely reflect the extent to which patients feel they can function in everyday roles and are not impacted by mood. This suggests that higher than expected PtGA scores may offer an opportunity to discuss patient expectations regarding roles and activities and the impact of their RA symptoms on daily function.

Reexamining remission definitions in rheumatoid arthritis: considering the 28‐joint Disease Activity Score, C‐reactive protein level, and patient global assessment: comment on the article by Felson et al

“…This is, therefore, not the reason "why high patient global assessment scores, even when 28-joint counts are low, identify patients at high risk of later functional loss" (1). This may be simply and better explained by the fact that function is a major determinant of PGA, irrespective of (inflammatory) disease activity, as repeatedly reported (5,6,8,13). These publications are the basis of our dual target strategy proposal, which we hypothesize may result in more accurate and comprehensive definitions of remission.…”

Defining the relationship between pain intensity and disease activity in patients with rheumatoid arthritis: a secondary analysis of six studies

“…Such variation in how people interpret the PtGA has been described in a mixed-methods study of 33 patients with RA, which reported that patients considered their pain, fatigue, function and psychological well-being, with comorbidities and RA sequelae also influencing scoring [ 30 ]. Other studies using quantitative approaches also demonstrate strong associations between PtGA and function, emotional distress and social participation [ 7 , 8 , 31 ]. In addition, the relationship between pain intensity and PtGA scores reflects previous research on the subjective components of disease activity scores by McWilliams and colleagues [ 32 ].…”

Correspondence on ‘Re-examining remission definitions in rheumatoid arthritis: considering the 28-joint Disease Activity Score, C reactive protein level and patient global assessment’

“…This is, therefore, not the reason ‘why high patient global assessment scores, even when 28-joint counts are low, identify patients at high risk of later functional loss’ 1. This may be simply and better explained by the fact that function is a major determinant of PGA, irrespective of (inflammatory) disease activity, as repeatedly reported 5 6 8 13. These publications are the basis of our ‘Dual Target Strategy’ proposal, which we hypothesise, may result in more accurate and comprehensive definitions of remission.…”