Session Type: Abstract Submissions (ACR)
Modern treatment strategy in RA aims at remission. In 2011, new ACR/EULAR remission criteria were published for patients with RA. Of four Boolean criteria, one is a patient-reported outcome: The patient’s global score (PATGL), which reflects how much the disease affects the patient’s life at the present. It has been criticized that patient’s pain score (PAIN) is not included, since pain is the single largest problem for patients with RA. Our aim was to investigate how such a modification of the remission criteria, replacing PATGL with PAIN, would impact achievement of remission in patients treated in routine care.
The DANBIO registry is a nationwide, Danish database that is used by all public hospital departments of rheumatology and many rheumatologists in private practice. Patients are followed prospectively and PATGL, PAIN, as well as doctor’s global (DOCGL) and FATIGUE scores are collected routinely at all visits. For the present study, the latest visit for each patient was selected.
A total of 16,154 patients with RA were included (age: 65 years (55-73) (median(25-75%)), disease duration: 8 years (3-16), 28.4% men, 86.5% IgM-RF positive, 25.0%/75.0% treated with biologics/sDMARD, HAQ: 0.625(0.125-1.375), DAS28CRP: 2.5 (1.8-3.4)).
16.5% of the patients fulfilled the Boolean criteria for remission (SJC≤1, TJC≤1, CRP≤10mg/L, and PATGL ≤10mm). PATGL and PAIN were closely correlated (Spearman’s rho=0.86, p<0.0001).
If PATGL was substituted by PAIN, the remission rate was largely similar: 18.0%, but 5% (680/13,485 pts) changed status from no remission to remission, and 16.7% (446/2,669 pts) from remission to no remission.
If PATGL was substituted by FATIGUE, the remission rate was 13.2% (with 3% of patients (400/13,178) changing status from no remission to remission, and 36% of patients (946/2627) from remission to no remission.
If PATGL≤10 mm was substituted by PATGL≤20mm, the remission rate increased to 25.7%.
If PATGL was substituted by DOCGL, the remission rate increased to 45.4%, and 35.6% of patients (4,598/12,928) changed from no remission to remission, and 5.3% (138/2584) from remission to no remission.
In >15,000 RA patients treated in routine care in a treat-to-target setting, 16.5% fulfilled the 2011 ACR/EULAR Boolean remission criteria at their latest visit. Substitution of patient’s global with pain score only changed the remission rate marginally. In accordance with this, the two scores were highly correlated. In contrast, substituting patient’s global with doctor’s global score almost tripled the fraction of patients in remission. The finding underscores the importance of inclusion of patient-reported outcomes in the remission criteria, but PATGLO and PAIN seemed to capture largely the same patients as being in remission.
M. L. Hetland,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/acreular-remission-in-ra-patients-in-clinical-practice-does-substitution-of-patient-global-with-pain-score-change-remission-rates-data-from-the-danish-danbio-registry/