Background/Purpose: Patient global assessment (PtGA) is an element of the new ACR/EULAR remission criteria for rheumatoid arthritis (RA). This definition has been reported to better predict structural or functional outcomes than DAS28, and we have also reported the importance of maintaining stringent remission to avoid progressive functional damage (ACR 2011 #332). Boolean-based remission for clinical trials (Boolean trials) consists of 4 components: (tender [TJC28] and swollen joint counts [SJC28] as assessed by 28 joints, C-reactive protein [mg/dL], and PtGA (0-10 scale) values being ≤1). In most patients, whether Boolean trials remission is achieved or not depends on PtGA. It is therefore necessary to reveal what factors are significantly associated with PtGA.

Methods: The Institute of Rheumatology, Rheumatoid Arthritis (IORRA), is a hospital-based large observational cohort of RA patients. Clinical information and laboratory data have been collected biannually since 2000. Pain, PtGA, and physician global assessment (PhGA) scores were rated using a Visual Analogue Scale (0-10 cm). The validated Japanese versions of Health Assessment Questionnaire (J-HAQ) scores and European Quality of life 5 Dimensions (EQ-5D) ratings were used to evaluate physical function and quality of life (QOL), respectively. The subjects in this study were RA patients who participated in the IORRA survey during April 2011. Correlations between PtGA score and clinical parameters, including medications and pain VAS, J-HAQ, PhGA, and EQ-5D were examined by Spearman’s correlation. Univariate and multivariate logistic regression models were used to evaluate the effect of clinical parameters on PtGA scores of >1 compared to PtGA scores of ≤1.  Odds ratios (OR) with 95% confidence intervals (CI) were calculated using the JMP 9.0. software package.

Results: We analyzed 5,276 Japanese RA patients from whom all 4 components of Boolean trials remission were available. TJC28, SJC28, and CRP were satisfied in 78.3%, 72.8% and 84.4% of them, respectively. By contrast, only 31.3% of the patients fulfilled PtGA scores of ≤1, but among them, Boolean trials remission was achieved in 76.9%. PtGA was closely correlated with J-HAQ (r = 0.54), EQ-5D (r = 0.66) and pain VAS (r = 0.86). In multivariate analyses, significant factors associated with a PtGA score >1 were J-HAQ (OR = 1.96; 95% CI, 1.61-2.40; p<0.001), non-steroidal anti-inflammatory drug (NSAID) use (OR = 1.40; 95% CI, 1.20-1.64; p<0.001), TJC28 (OR = 1.26; 95% CI, 1.17-1.36; p<0.001), SJC28 (OR = 1.11; 95% CI, 1.05-1.16; p<0.001), CRP (OR = 1.18; 95% CI, 1.06-1.33; p = 0.003), age (OR = 0.99; 95% CI, 0.98-0.99; p<0.001), and EQ-5D (OR = 0.001; 95% CI, 0.000-0.001; p<0.001). 

Conclusion: In RA patients, a PtGA score of ≤1 was associated with not only joint involvements (TJC, SJC), inflammation (CRP), and physical dysfunction, but also impaired QOL, younger age, and NSAID use.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/analysis-of-factors-impact-on-patient-global-assessment-in-daily-practice-based-on-observational-cohort-iorra-institute-of-rheumatology-rheumatoid-arthritis/