Session Information
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Patient global assessment (PtGA) is included in all the current remission definitions for RA despite the fact that PtGA is not exclusively related to disease activity and may be influenced by noninflammatory or psychological processess. In this study in order to objectively identify whether patient’s assessment is better than physician’s (Ph) or not, we compared disease activities assessed with ultrasound (US) of Boolean remission patients with PtGA and Boolean remission patients with PhGA but not PtGA.
Methods: RA patients in clinical remission (DAS28-ESR<2.6) for at least 3 months were included. Boolean based remission definition and modified versions by substitution of PtGA with PhGA and by omitting PtGA were determined. A standard gray scale (GS) and power Doppler (PD) US examination of 28 joints (included in DAS28) for the presence of synovitis was performed by an experienced sonographer (NI) blinded to clinical data. US synovitis GS and PD signals were semiquantitatively graded from 0 to 3 and were recorded as sum scores of PD and GS, respectively.
Results: A total of 55 out of 302 RA patients (18.2%) in DAS28 remission were enrolled (F/M=35/20, mean age 52.2±12.0, disease duration 11.011.0±6.5 years, bDMARDs 43.6%, RF/Anti-CCP positivity 76.4%). Of 55 patients, 25 (45.5%) fulfilled the Boolean criteria. When PtGA was substituted with PhGA, remission rate increased to 72.7% (n=40) and when PtGA was omitted remission rate increased to 89.1% (n=49) (P<0.001 for both). Regarding US disease activity no PD, no GS and no PD+GS signals were observed in 9 (36%) vs 12 (30%), 7 (28%) vs 8 (20%) and 6 (24%) vs 7 (17.5%) patients in Boolean remission with PtGA and PhGA, respectively (P>0.05 for all). When PD and GS signals ≥ grade 2 were taken into account, % of patients without PD, GS or both signals were also similar (respectively, 16 [64%] vs 25 [62.5%], 12 [48%] vs 18 [45%] and 12 [48%] vs 17 [42.5%]). US disease activity parameters of Boolean PtGA remission and nonremission patients were compared as well, no significant difference was observed. On the other hand patients in Boolean PhGA remission had significantly lower PD scores (without grade 1) compared to Boolean PhGA nonremission (Table 1). In comparison of US disease activity of patients in Boolean PtGA remission and in Boolean remission with PhGA but not PtGA, the median PD and GS synovitis sum scores and the % of patients with no PD or GS signals were not statistically different.
Conclusion: RA patients in Boolean remission with PhGA do not have higher disease activity that is verified by US, compared to patients in Boolean remission with PtGA. Furthermore Boolean remission with PhGA better differentiates patients with US evinced inflammation. These data suggest that PtGA might be substituted with PhGA in Boolean criteria. Prospective follow up and recruitment of more patients will clarify the consistency of these results over time and impact of this substitution on functionality.
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Table 1. US disease activity parameters of remission and nonremission patients according to Boolean based criteria with PtGA and PhGA* |
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Boolean remission with PtGA (n=25) |
Boolean non-remission with PtGA (n=30) |
P value |
Boolean remission with PhGA (n=40) |
Boolean non-remission with PhGA (n=15) |
P value |
|
PD synovitis sum score (0-84) |
1 (0-4.5) |
2.5 (0-6.2) |
0.26 |
1 (0-4) |
4 (0-7) |
0.26 |
|
PD synovitis sum scores (without counting grade 1 signals) |
0 (0-3) |
1 (0-6) |
0.20 |
0 (0-3.5) |
4 (0-6) |
0.045 |
|
GS synovitis sum score (0-84) |
3 (0-6.5) |
4 (1-8.2) |
0.32 |
3.5 (1-8) |
4 (1-9) |
0.59 |
|
GS synovitis sum scores (without counting grade 1 signals) |
2 (0-5) |
2 (0-7.2) |
0.39 |
2 (0-6) |
4 (0-8) |
0.58 |
|
US joint count with PD signal (0-28) |
1 (0-3) |
2 (0-3.2) |
0.32 |
1 (0-3) |
2 (0-4) |
0.36 |
|
US joint count with PD signal (without counting grade 1 signals) |
0 (0-1.5) |
0.5 (0-3) |
0.21 |
0 (0-1.7) |
2 (0-3) |
0.090 |
|
US joint count with GS signal (0-28) |
2 (0-4.5) |
3 (1-4) |
0.37 |
2 (1-4) |
3 (1-4) |
0.73 |
|
US joint count with GS signal (without counting grade 1 signals) |
1 (0-2.5) |
1 (0-3.2) |
0.39 |
1 (0-3) |
3 (1-4) |
0.61 |
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USDAS28PD |
2.35 (1.82-2.91) |
2.55 (2.26-2.8) |
0.32 |
2.47 (1.99-2.83) |
2.50 (2.31-2.83) |
0.35 |
|
USDAS28GS |
2.35 (1.88-3.03) |
2.69 (2.3-2.9) |
0.31 |
2.54 (2.02-2.99) |
2.60 (2.40-2.90) |
0.49 |
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*The values were presented as median (25-75).
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To cite this abstract in AMA style:
Ozen G, Unal AU, Topcu A, Atagunduz P, Direskeneli H, Inanc N. Patient Global Assessment in Evaluating Boolean-Based Remission in Rheumatoid Arthritis-Is It Really Required Instead of Physician Global Assessment? a Comparative Study with Ultrasound [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/patient-global-assessment-in-evaluating-boolean-based-remission-in-rheumatoid-arthritis-is-it-really-required-instead-of-physician-global-assessment-a-comparative-study-with-ultrasound/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/patient-global-assessment-in-evaluating-boolean-based-remission-in-rheumatoid-arthritis-is-it-really-required-instead-of-physician-global-assessment-a-comparative-study-with-ultrasound/