Background/Purpose: RA patients frequently encounter challenges in effectively communicating their symptoms to medical professionals. Recently, the “Okomarigoto Sheet” (OS), an illustration-based patient-reported outcome measure for RA patients, was developed and has been widely used in Japan. However, the OS’s correlation with the conventional patient-reported outcome (PRO) has not been sufficiently evaluated. This study aims to investigate whether items on the OS are related to conventional measures of disease activity and PRO, and assess its effectiveness in facilitating patients’ expression of their symptoms.

Methods:  Participants were recruited from four clinics. The OS consists of three symptom scales – morning stiffness duration, the Visual Analogue Scale (VAS) for joint pain and fatigue (0 = none, 100 mm = very severe). Illustrations depicting symptoms in five different situations were also provided for each symptom. Each illustration is scored as follows: no symptoms = 0, mild-moderate symptoms = 1, severe symptoms = 2. The total score of 5 illustrations for each symptom ranges from 0-10, with the total score of whole illustrations ranges from 0 to 30; indicating symptom severity. The correlations between the total illustration score and disease activity and QOL (SF-12) were evaluated. The correlations between patient global assessment (PGA), evaluator global assessment (EGA), and swollen joint count (SJC) and the total score of 5 illustrations for each symptom were also analyzed. Statistical analysis was conducted using Spearman’s rank correlation coefficient.

Results: 80 patients (mean age: 61 years old) responded to the questionnaire. The total score of whole illustrations was positively correlated with DAS28 (rs= 0.538) and CDAI (0.648), and negatively correlated with Physical Component Summary (-0.534) and Mental Component Summary (-0.417) of SF-12. Stiffness duration, pain and fatigue VAS were positively correlated with total score of 5 illustrations for each symptom. Of the patients who scored 0 on stiffness duration, pain and fatigue VAS, 9 patients had symptoms in the illustrations (5 for stiffness; 1 for pain; 4 for fatigue). In addition, PGA was significantly correlated with all of total score of 5 illustrations for each symptom (stiffness: rs=0.551, pain: rs=0.651, fatigue: rs= 0.353, respectively). However, EGA was significantly associated with the total scores of 5 illustrations for stiffness (rs=0.476) and pain (rs=0.449), but not fatigue (rs= 0.164). SJC was also associated with the total scores of 5 illustrations for stiffness (rs=0.263) and pain (rs=0.379), but not fatigue (rs= 0.083).

Conclusion: The illustration-based OS reflected the findings obtained using standard measures of disease activity and QOL. It has also the potential to clarify symptoms that are not adequately captured by VAS. Furthermore, total score of 5 illustrations for fatigue was associated with PGA but not with EGA and SJC. It was reported that EGA is most closely associated with SJC. Therefore, utilizing OS not only clarifies patients’ symptoms in greater detail, but also suggests that fatigue may be one of the factors contributing to the discrepancy between PGA and EGA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/an-illustration-based-patient-reported-outcome-measure-reveals-concealed-symptoms-in-patients-with-rheumatoid-arthritis-and-the-factor-contributing-to-the-discrepancy-between-patient-and-evaluator-glo/