ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2241

Assessing Significant Flares In Rheumatoid Arthritis: Validity Of The Outcome Measures In Rheumatology Preliminary Flare Questions In The Canadian Early Arthritis Cohort

Susan J. Bartlett1,2, Clifton O. Bingham III3, Ernest Choy4, Juan Xiong5, Gilles Boire6, Boulos Haraoui7, Janet E. Pope8,9, J. Carter Thorne10, Carol A. Hitchon11, Diane Tin12, Edward C. Keystone13 and Vivian P. Bykerk13,14, 1Clinical Epidemiology, McGill University, Montreal, QC, Canada, 2Division of Rheumatology, Johns Hopkins University, Baltimore, MD, 3Rheumatology, Johns Hopkins University, Baltimore, MD, 4Section of Rheumatology, Cardiff University, Institute of Infection and Immunity, Cardiff, United Kingdom, 5Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada, 6Rheumatology Division, Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC, Canada, 7Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada, 8St Joseph Health Care, London, ON, Canada, 9Univ of Western Ontario, London, ON, Canada, 10Southlake Regional Health Centre, Newmarket, ON, Canada, 11Rheumatology, University of Manitoba, Winnipeg, MB, Canada, 12The Arthritis Program, Southlake Regional Health Centre, Newmarket, ON, Canada, 13Medicine, Mount Sinai Hospital/University of Toronto, Toronto, ON, Canada, 14Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: , ,

Session Information

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

Session Type: Abstract Submissions (ACR)

Background/Purpose: Rheumatoid arthritis (RA) flares are common, poorly defined, and understudied. A tool is needed to measure significant RA flares that may signal need for evaluation for treatment change. Qualitative and quantitative research by the OMERACT RA Flare Group with patients and providers has identified an RA Flare Core Domain Set, ratified by OM 2012 attendees. Next, we identified preliminary flare questions (PFQs) to assess core domains. Here, we report evidence of discriminant validity of PFQs between patients who report flaring and those not in flare and convergent validity among PFQs and validated RA measures in a cohort of patients with early RA (ERA). 

Methods: 1190 patients in the Canadian early ArThritis CoHort (CATCH) completed PFQs at visits from 11-2011 through 5-2013. Both patients and MDs independently rated if patient was in flare. Patients completed PFQs for pain, physical function (PF), fatigue, stiffness, participation and coping over 1 week prior to visit using 11-point scales, as well as HAQ, SF12, RADAI, WPAI and Patient Global. Wilcoxon rank sum and χ2 were used to compare groups. Correlations (Spearman, polychoric, polyserial) were calculated between PFQs and relevant HAQ, SF12, WPAI, RADAI items and other scales. 

Results: Participants were mostly female (74%), white (81%), and 55% had > high school education. Mean (SD) age was 53 (15) years and RA duration 6 (3) months. 33% of patients and 38% of MDs classified patient as being in flare; agreement for being in flare was 62% and not in flare 73% (kappa = .33; 95% CI .28-.39). Scores were significantly higher across all domains in patients reporting flare (Table). Correlations were strongest between PFQ pain and other pain scales (r’s=.84-.88). Moderate-strong correlations were evident among PFQ with other measures of PF (r’s= .63-.75), fatigue (r’s= .52-.85), stiffness (r=.66), participation (r’s=.60-.77) and coping (r’s=.30-.55).  

Conclusion: In ERA patients who report being in flare, PFQ scores were significantly higher across all domains. There was substantial agreement among single item PFQs and other validated RA measures. Results provide evidence of the validity of OMERACT PFQs to assess flares in RA patients. Additional psychometric evaluation is needed to establish the reliability, validity, and responsiveness of items and relevant thresholds across a range of RA populations and settings prior to widespread use.

 

Comparison of OMERACT PFQ domain scores in patients reporting and not reporting being in RA flare (N=1190).

 

Not in Flare

Flare

Significance

Reported RA as worse* in past week

43%

17%

<.001

OM PFQs†

 

 

 

   Pain

2.5 + 2.5

6.0 + 2.6

<.0001

   Physical Function

2.2 + 2.5

5.5 + 3.0

<.0001

   Fatigue

2.7 + 2.8

5.3 + 3.1

<.0001

   Stiffness

2.4 + 2.5

5.6 + 2.9

<.0001

   Participation

2.0 + 2.5

5.1 + 3.1

<.0001

   Coping

1.8 + 2.3

4.3 + 2.8

<.0001

†Higher scores reflect great impairment; *slightly worse, worse or much worse.

 

Disclosure:

S. J. Bartlett,
None;

C. O. Bingham III,

OMERACT,

6;

E. Choy,
None;

J. Xiong,
None;

G. Boire,
None;

B. Haraoui,
None;

J. E. Pope,
None;

J. C. Thorne,
None;

C. A. Hitchon,
None;

D. Tin,
None;

E. C. Keystone,
None;

V. P. Bykerk,

Various,

2.

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