Background/Purpose: Efforts
have been made in recent years to standardize the clinical assessment of RA
patients with increased focus on objective measures, such as the DAS28.

The objective of the current study was
to compare physicians’ perceptions of the severity of their patients’ RA
against the patients’ DAS28, treatment, and quality of life.

Methods: Data
were drawn from the Adelphi 2014 RA Disease Specific Programme, a survey of
rheumatologists and their RA patients in France, Germany, Italy, Spain and UK. Rheumatologists
provided patient clinical details including DAS28, physician perceived disease
severity (mild/ moderate/ severe) and treatment history. Patients completed the
EuroQoL 5-Dimension Health Questionnaire (EQ-5D) and Work Productivity Activity
Impairment (WPAI) questionnaire. Three cohorts were created based on the
physician’s perceived severity of the patient’s RA: mild, moderate, severe and
were compared across DAS28 (as reported by the physician), treatment history,
EQ-5D and WPAI. Appropriate univariate tests were used to compare subgroups
statistically.

Results: 307
rheumatologists provided records for 2,536 patients, of whom 68.8% were
perceived to have currently mild RA, 27.1% moderate RA and 4.2% severe RA.
Comparisons of mean DAS28 scores across groups showed an increase in mean score
as severity worsened (DAS28: 2.48, 3.81, 5.45 for mild, moderate and severe,
respectively; p<0.01). When DAS28 was categorized based on agreed
definitions of remission (<2.6), low disease activity (LDA; ≥2.6
and ≤3.2) and active disease (>3.2) the percentage of mild patients in
each DAS28 category was 53.2%, 34.5% and 12.3%, respectively; moderate
patients: 9.2%, 22.4% and 68.3%; and severe patients: 5.6%, 2.8% and 91.7%
(p<0.01). 47.2% of patients who are currently severe have been prescribed a
biologic DMARD (bDMARD) therapy, which was higher than for patients who are
currently moderate (39.1%) or mild (34.9%).

Higher disease activity scores were
associated with lower EQ-5D scores indicating worse quality of life (EQ-5D:
0.81, 0.60, 0.21 for mild, moderate and severe, respectively; p<0.01), and
overall work impairment increased (18.8%, 37.6% and 55.9% for mild, moderate
and severe, respectively; p<0.01).

Conclusion:
Results showed that in general
rheumatologists’ labels of mild, moderate and severe RA correlate with more
objective measures of disease activity (DAS28) and impact on the patient (EQ-5D
and WPAI), although the finding that some patients classed as ‘mild’ have
active RA (DAS28 >3.2) implies active disease can still be overlooked and
potentially undertreated.

Additionally, the finding that less than
half of patients who are currently severe had received a bDMARD therapy
suggests a certain population of patients may not receive bDMARD therapy
regardless of the severity of their RA, and may benefit from an alternative
efficacious treatment option.