Session Information
Title: Rheumatoid Arthritis - Clinical Aspects: Novel Biomarkers and Other Measurements of Disease Activity
Session Type: Abstract Submissions (ACR)
Background/Purpose
Fatigue is an important issue for patients with rheumatoid arthritis (RA). The ACR/EULAR Boolean definition of remission comprises values <=1/10 for joint counts, CRP and patient global assessment; fatigue is not specifically assessed. Near-remission (defined as remission for joint counts and CRP but with patient global assessment > 1/10) is a status which may, or may not, be an acceptable objective for patients. Fatigue levels in this status are unknown.
Objectives: To assess fatigue levels and other aspects of impact, in patients in ACR/EULAR remission, compared to patients in near-remission and not in remission.
Methods
Ancillary analysis of the RAID database, based on an international multicenter cross-sectional study of consecutive RA patients from 12 European countries, and the baseline data in COMEDRA, a French national study in stable RA patients (refs 1, 2). Remission, near-remission and non-remission were assessed cross-sectionally and patient-reported impact of RA including fatigue was assessed using the RA Impact of Disease (RAID) score (ref 1). The RAID assesses pain, function, fatigue, sleep, coping and well-being; each component of the RAID score ranges from 0 (no impact) to 10 (high impact). Patients in remission were compared to those in near-remission and not in remission for mean levels and the proportion of patients with a score <=1/10, in each of the RAID components. The discriminant capacity of fatigue and of the other RAID components for the status of remission was assessed by Cohen’s effect size.
Results
In total, 1284 patients had complete data for this analysis: mean (±standard deviation) age 57±11 yrs, disease duration 13±10 yrs, 78% women. Mean RAID score was 3.3±2.2. Mean fatigue in this population was 4.1±2.7. With the ACR/EULAR Boolean definition, only 87 (6.8%) were in remission and 84 (6.5%) were in near-remission. In remission patients, all the components of the RAID were very low (mean value below 1), except fatigue (mean value of 1.2±1.8; i.e., fatigue was above 1/10 in 25% of the patients in remission, versus 9-21% for the other aspects of RA impact. Near-remission was characterised by more impact of RA for all components of the RAID but particularly fatigue (mean fatigue 4.0±2.3, similar to patients not in remission: 4.3±2.7). Fatigue levels, psychological well-being and sleep had the lowest discriminant capacity to distinguish patients in remission versus not.
Conclusion
The ACR/EULAR definition of remission is extremely stringent and rarely attained for patients with long-standing RA. Fatigue was the only aspect of the impact of RA to remain at significant levels for many patients in Boolean remission, and was much higher in patients in near-remission. More work is needed to understand the link between fatigue and disease activity.
Disclosure:
L. Gossec,
None;
B. Fautrel,
None;
J. Kirwan,
None;
A. Balanescu,
None;
M. de Wit,
None;
B. A. C. Dijkmans,
None;
M. Englbrecht,
None;
P. Gaudin,
None;
F. Gogus,
None;
T. Heiberg,
None;
T. K. Kvien,
None;
E. Martín-Mola,
None;
M. Matucci-Cerinic,
None;
K. Otsa,
None;
A. Ruyssen-Witrand,
None;
T. Sokka-Isler,
None;
M. Soubrier,
None;
M. Dougados,
None.
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