How Often Are Core Variables Reported To Calculate Common Disease Activity Scores Measured In Routine Care Of Rheumatoid Arthritis Patients?

Bindee Kuriya¹, Jessica Widdifield^2,3, Claire Bombardier⁴, Xiuing Li⁵, Binu Jacob⁶, Pooneh Akhavan⁷, J. Carter Thorne⁸, Janet E. Pope⁹, Edward C. Keystone¹⁰, William G. Bensen¹¹ and Vandana Ahluwalia¹², ¹Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada, ²Institute for Clinical Evaluative Sciences, Toronto, ON, Canada, ³University of Toronto, Toronto, ON, Canada, ⁴Rheumatology, University of Toronto, Toronto, ON, Canada, ⁵University of Toronto, University Health Network, Toronto, ON, Canada, ⁶University Health Network, Toronto General Research Institute, Toronto, ON, Canada, ⁷Medicine, Mount Sinai Hospital/University of Toronto, Toronto, ON, Canada, ⁸Southlake Regional Health Centre, Newmarket, ON, Canada, ⁹St Joseph Health Care, London, ON, Canada, ¹⁰Rebecca MacDonald Centre for Arthritis and Autoimmune Disease, University of Toronto, Toronto, ON, Canada, ¹¹Department of Medicine, Division of Rheumatology, Clinical Professor, McMaster University, Hamilton, ON, Canada, ¹²William Osler Health Center, Brampton, ON, Canada

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: Disease Activity and rheumatoid arthritis (RA)

Session Information

Title: Rheumatoid Arthritis-Clinical Aspects III: Outcome Measures, Socioeconomy, Screening, Biomarkers in Rheumatoid Arthritis

Session Type: Abstract Submissions (ACR)

Background/Purpose: Treat-to-target (T2T) is a therapeutic strategy in rheumatoid arthritis (RA) that has been associated with improved outcomes. T2T relies on objective measurement of disease activity at regular intervals with escalation of treatment until remission or low disease activity is achieved. In clinical trials, variables needed to assess disease activity are routinely collected but the ability to do the same in clinical practice is uncertain. The objective of this study was to determine the frequency by which core variables needed to calculate common disease activity scores are collected in a cohort of RA patients followed in routine care.

Methods: All patients (N=2018) enrolled in the Ontario Best Practices Research Initiative since its inception in 2009 were included in this study. OBRI is a clinical registry of RA patients with both early and established disease and are treated according to the discretion of the rheumatologist. We determined the frequency by which components required to calculate common composite disease activity scores (DAS28, SDAI, CDAI) were collected and documented during the first 6 consecutive visits: physician global health assessment (MDGA), patient global health assessment (PtGA), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), tender joint count-28 (TJC) and swollen joint count-28 (SJC). Results are reported as the % of measured variables, expressed as the number of measured components divided by the number of patients at each visit.

Results: At entry into the cohort, 77% of patients were female with mean (SD) age 57 (13) years, and the majority (85%) was Caucasian. Patients had moderate disease activity according to both mean (SD) DAS28 4.5 (1.5) and CDAI scores 21(14). Over time, the % measurement was consistent for most variables with the exception of ESR and CRP, which had a higher frequency of measurement at cohort entry (visit 1) than subsequent visits. Documentation of TJC and SJC assessment was universally high at each visit and ranged from 92-96%. Global health assessment reported by physicians (MDGA range 85-89%) and patients (PtGA range 88-90%) were similar. Missing data was greatest for values of CRP (missing range 29-40%) (Table).

Conclusion: Measurement of core variables required to assess RA disease activity are collected in a majority of RA patients followed in routine clinical practice. Objective measures such as TJC and SJC have near perfect collection. MDGA and PtGA are missing in ~15% of visits and measurement of inflammatory markers are sub-optimal which may limit calculation of composite scores that drive T2T strategies and comparison of disease activity to other cohorts. Further work determining potential barriers to collection of these variables is needed.

Table. Frequency (%) of core component measurement in the OBRI cohort.

	Visit 1 (N=2081)	Visit 2 (N=1811)	Visit 3 (N=1530)	Visit 4 (N=1185)	Visit 5 (N=873)	Visit 6 (N=670)
MDGA	87	85	86	87	89	87
PtGA	89	88	88	89	90	90
ESR	85	76	76	77	77	77
CRP	71	60	66	69	67	68
TJC	94	92	92	93	93	94
SJC	96	95	95	95	96	96

Disclosure:

B. Kuriya,
None;

J. Widdifield,
None;

C. Bombardier,
None;

X. Li,
None;

B. Jacob,

OBRI was funded by peer reviewed grants from CIHR (Canadian Institute for Health Research), the Ontario Ministry of Health and unrestricted grants from: Abbvie, Amgen, Bristol Myers Squibb, Pfizer, UCB, Janssen and Roche.,

P. Akhavan,

J. C. Thorne,
None;

J. E. Pope,
None;

E. C. Keystone,

AbbVie Inc., AstraZeneca, Biotest, BMS, Centocor, Genentech, Merck, Nycomed, Pfizer, Roche, and UCB,

AbbVie Inc., Amgen, AstraZeneca, BMS, Centocor, Genzyme, Merck, Novartis, Pfizer, Roche, and UCB,

AbbVie Inc., Amgen, BMS, Janssen, Merck, Pfizer, Roche, and UCB,

W. G. Bensen,
None;

V. Ahluwalia,
None.

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