“From Where I Stand”: Using Multiple Anchors Yields Different Benchmarks for Meaningful Improvement and Worsening in the Rheumatoid Arthritis Flare Questionnaire (RA-FQ)

Susan Bartlett¹, Vivian Bykerk², Orit Schieir³, Marie-France Valois¹, Louis Bessette⁴, Gilles Boire⁵, Glen Hazlewood⁶, Carol Hitchon⁷, Edward Keystone⁸, Janet Pope⁹, Diane Tin¹⁰, Carter Thorne¹¹, Clifton Bingham¹² and CATCH Investigators¹³, ¹McGill University, Montréal, QC, Canada, ²Hospital for Special Surgery, New York, NY, ³Canadian Early Arthritis Cohort Study, Montréal, QC, Canada, ⁴Centre de l'Ostoporose et de Rhumatologie de Qubec, Québec City, QC, Canada, ⁵Universite de Sherbrooke, Sherbrooke, QC, Canada, ⁶University of Calgary, Calgary, AB, Canada, ⁷University of Manitoba, Winnipeg, MB, Canada, ⁸Keystone Consulting Enterprises Inc., Toronto, ON, Canada, ⁹University of Western Ontario, London, ON, Canada, ¹⁰The Arthritis Program Research Group, Newmarket, ON, Canada, ¹¹Southlake Regional Health Centre, Newmarket, ON, Canada, ¹²Johns Hopkins University, Baltimore, MD, ¹³Canadian Early Arthritis Cohort Investigators, Toronto, ON, Canada

Meeting: ACR Convergence 2021

Keywords: Disease Activity, flare, Measurement Instrument, Outcome measures, rheumatoid arthritis

Session Information

Date: Tuesday, November 9, 2021

Title: Abstracts: Measures & Measurement of Healthcare Quality (1893–1896)

Session Type: Abstract Session

Session Time: 10:30AM-10:45AM

Background/Purpose: The RA-FQ is a patient-reported measure of current disease activity in RA that can be used to identify disease flares. The RA-FQ queries pain, physical function, fatigue, stiffness, and participation and yields a score from 0-50. We previously reported on reliability, validity, and responsiveness. Our goal was to compare changes in the RA-FQ that represent minimal and meaningful improvement or worsening from the perspective of people living with RA, treating rheumatologists, and in relation to disease activity indices.

Methods: We used data from adults with early RA (symptoms < 1 year) enrolled in the CATCH (Canadian Early Arthritis Cohort), a prospective study of real-world patients treated across Canada. Participants completed the RA-FQ, Patient Global, and RA Global Change Impression item (a little vs. a lot better or worse or same) at 3- and 6-month visits. Rheumatologists recorded joint counts and MD Global. We compared mean change across categories of improvement and worsening disease activity using patient, physician and CDAI anchors and created cumulative distribution function curves to visually examine separation among categories.

Results: The 808 adults were mostly white (84%) women (71%) with a mean (SD) age of 55 (15) and moderate-high disease activity (85%) at enrollment. At the second visit, 79% of patients reported that their RA had changed; 59% were better and 20% worse. Patients who were a lot worse had a mean increase of 8.9 points whereas those who rated themselves as a lot better had a -6.0 decrease on the RA-FQ (Figure). Minimal worsening and improvement were associated with 4.7 and -1.8 change on the RA-FQ, respectively, while patients who rated their RA unchanged had stable RA-FQ scores (Table). Physicians and CDAI classified more patients as worse than patients, and minimal and meaningful RA-FQ thresholds differed by group. Similar changes were evident in CDAI, SDAI, and DAS indices (Table). Larger differences were observed with patient vs. physician global scores and tender vs. swollen joints. Across measures, the change associated with worsening was greater than for improvement. Results supported all prespecified hypotheses.

Conclusion: In this large cohort of adults with ERA, the RA-FQ was responsive to change and generally distinguished between minimal and meaningful improvement and worsening. These data add to growing evidence demonstrating robust psychometric properties of the RA-FQ and offer initial guidance about the amount of change associated with improvement or worsening, supporting its use in RA care, research and decision-making.

Change in RA-FQ scores between visits by patient ratings of RA status.

Cumulative distribution function curves for patient, physician and CDAI anchors.

Disclosures: S. Bartlett, Merck Canada, 2, 6, Pfizer Canada, 2, 6, Janssen Canada, 2, 6, PROMIS Health Organization, 4, American Thoracic Society, 4, Arthritis Health Professionals Association, 4, UCB, 1, RAND Corporation, 1; V. Bykerk, Amgen Inc., 2, 6, Bristol Myers Squibb, 2, 6, Gilead, 2, 6, Pfizer, 2, 6, Regeneron, 2, 6, Sanofi-Genzyme, 2, 6, UCB, 2, 6; O. Schieir, None; M. Valois, None; L. Bessette, Amgen, 2, 5, 6, Bristol-Myers Squibb, 2, 5, 6, Janssen, 2, 5, 6, Roche, 2, 5, 6, UCB, 2, 5, 6, AbbVie, 2, 5, 6, Pfizer, 2, 5, 6, Merck & Co, 2, 5, Celgene, 2, 5, 6, Sanofi, 2, 5, 6, Eli Lilly, 2, 5, 6, Novartis, 2, 5, 6, Gilead, 2, 5, 6, Sandoz, 2, 5, 6, Teva, 2, 6; G. Boire, Abbvie, 1, 6, 7, BMS, 6, 7, Janssen, 1, 5, 6, Eli Lilly, 1, 7, Amgen, 7, Novartis, 6, 7, Pfizer, 7, Sandoz, 6, 7, Viatris, 1, 6, Samsung Bioepis, 1; G. Hazlewood, None; C. Hitchon, Pfizer, 5, UCB Canada, 5; E. Keystone, AbbVie, 2, 6, Amgen, 2, 5, 6, Bristol-Myers Squibb Company, 2, Celltrion, 2, Gilead Sciences, 2, F. Hoffmann-La Roche, 2, 6, Janssen, 2, 6, Eli Lilly, 2, Merck, 2, 5, 6, Myriad Autoimmune, 2, Novartis, 6, Pfizer Inc, 2, 5, 6, PuraPharm, 5, Sandoz, 2, Sanofi-Genzyme, 2, 6, Samsung Bioepis, 2; J. Pope, AbbVie, 2, Amgen, 2, Bayer, 2, Bristol-Myers Squibb, 2, 5, Eli Lilly, 2, Merck, 2, Novartis, 2, Pfizer Inc, 2, Roche, 2, 5, Sanofi, 2, Seattle Genetics, 5, UCB, 2, 5, Actelion, 2, Sandoz, 2; D. Tin, None; C. Thorne, AbbVie, 1, Amgen Inc, 1, Celgene, 1, Eli Lilly, 1, Medexus/Medac, 1, 2, 6, Merck, 1, 2, Novartis, 1, 5, Pfizer, 1, 5, Sandoz, 1, Sanofi, 1, Centocor, 2; C. Bingham, Bristol Myers Squibb, 5, Abbvie, 2, Gilead, 2, Eli Lilly, 2, Janssen, 2, Regeneron, 2, Pfizer, 2, Sanofi, 2; C. Investigators, None.

To cite this abstract in AMA style:

Bartlett S, Bykerk V, Schieir O, Valois M, Bessette L, Boire G, Hazlewood G, Hitchon C, Keystone E, Pope J, Tin D, Thorne C, Bingham C, Investigators C. “From Where I Stand”: Using Multiple Anchors Yields Different Benchmarks for Meaningful Improvement and Worsening in the Rheumatoid Arthritis Flare Questionnaire (RA-FQ) [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 9). https://acrabstracts.org/abstract/from-where-i-stand-using-multiple-anchors-yields-different-benchmarks-for-meaningful-improvement-and-worsening-in-the-rheumatoid-arthritis-flare-questionnaire-ra-fq/. Accessed .

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