Is the Self-Assessment of Disease Activity (auto-DAS28) By Patients a Feasible and Acceptable Measure over the Long Term in Rheumatoid Arthritis (RA)? Three-Year Follow-up of a Nurse-Led Program in 771 Patients with Established RA

Laure Gossec¹, Frantz Foissac², Martin Soubrier³, Anna Molto⁴, Françoise Fayet⁵, Thomas Bardin⁶, Francis Berenbaum⁷, A Cantagrel⁸, Marie Hélène Cerato⁹, Gerard H. Chales¹⁰, Isabelle Chary-Valckenaere¹¹, Bernard Combe¹², Emmanuelle Dernis Labous¹³, Liana Euller-Ziegler¹⁴, Rene-Marc Flipo¹⁵, Philippe Gaudin¹⁶, Melanie Gilson¹⁷, Sandrine Guis¹⁸, Xavier Mariette¹⁹, Gaël Mouterde²⁰, Sophie Pouplin²¹, Pascal Richette²², Alain Saraux²³, Thierry Schaeverbeke²⁴, Jean Sibilia²⁵ and Maxime Dougados²⁶, ¹Rheumatology, Pitié Salpêtrière Hospital, Paris, France, ²COMEDRA working group, Paris, France, ³Rheumatology, Department of Rheumatology, CHU Gabriel Montpied, Clermont-Ferrand, France, ⁴Hopital Cochin, Paris Descartes University, Paris, France, ⁵Rheumatology, CHU Gabriel-Montpied, Clermont-Ferrand, France, ⁶Hôpital Lariboisière, Paris, France, ⁷Rheumatology dept, APHP St-Antoine hospital, Univ Paris 06, Paris, France, Paris, France, ⁸Purpan Hospital, Toulouse, France, ⁹University Hospital, Toulouse, France, ¹⁰CHU RENNES, Rennes, France, ¹¹University Hospital, Nancy, France, ¹²Département Rhumatologie, Hôpital Lapeyronie, Montpellier, France, ¹³Le Mans Hospital, Le Mans, France, ¹⁴Rheumatology, Nice, France, ¹⁵Rheumatology, University Hospital, Lille, France, ¹⁶Rheumatology, Grenoble University Hospital, France, Grenoble, France, ¹⁷Hopital Sud, Grenoble, France, ¹⁸Rheumatology 1, CRMBM-CEMEREM 7339, Aix-Marseille Université, AP-HM, CNRS, Marseilles, France, ¹⁹Rheumatology, Rheumatology department, Bicetre Hospital, Paris-Sud University, Le Kremlin Bicetre, France, ²⁰Rheumatology Department, Hopital Lapeyronie, Montpellier, France, ²¹Rheumatology Department & Inserm 905, Department of Rheumatology, Rouen University Hospital & Inserm 905, Institute for Biomedical Research, University of Rouen, Rouen, France, ²²Rhumatologie, Hôpital Lariboisière, Paris, France, ²³Rheumatology Department, CHU de la Cavale Blanche, Brest Cedex, France, ²⁴Rheumatology, CHU Bordeaux, Bordeaux, France, ²⁵Department of Rheumatology, Strasbourg University Hospital, Strasbourg, France, ²⁶Cochin Hospital and Paris 05 University, Paris, France

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: patient engagement, rheumatoid arthritis (RA) and self-management

Session Information

Date: Monday, November 14, 2016

Title: Quality Measures and Quality of Care - Poster II

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: Patients with RA can be trained in self-assessment of disease activity by a self-assessment of their joints and calculation of the Disease activity Score 28 (DAS28) (ref). Objective: To assess if such an auto-DAS assessment is a feasible measure over the long-term (i.e., do patients adhere to such an assessment?) and to determine the characteristics of patients related to adherence to auto-DAS.

Methods: This was an open long term (2-4 years) extension of the 6 month randomized controlled COMEDRA trial of patients with definite, stable RA. Patients were trained to perform auto-DAS by a nurse, using a video and teaching of self-assessment of joints (the training took approximately 30 minutes) and nurses provided the advice to perform the auto-DAS regularly in a dedicated booklet. 2-4 years after the end of the trial, patients were seen in a face-to-face interview with a nurse and the frequency of auto-DAS was assessed through the auto-DAS booklet and if unavailable, from patient questioning. Adherence to auto-DAS was defined as the performance of at least one auto-DAS more than 6 months after the end of the trial. Characteristics of adherent versus non adherent patients were compared by univariate and multivariate logistic regression analyses and included demographic and disease activity variables as well as the centre (higher versus lower than median inclusion number).

Results: Of the 970 recruited patients, 771 (79.5%) were followed up 3 years and had available data regarding auto-DAS: mean (±SD) age 61 (±11) years, median [IQR] disease duration 15 [9 – 23] years; 615 (80%) were women and 82% had received a biologic. The mean (±SD) baseline and 3-year DAS28 scores were respectively 3.1±1.3 and 2.8±1.4. After 3 years, 354 (46%) patients were adherent to auto-DAS (i.e., had at least one auto-DAS completed more than 6 months after the end of the trial). For adherent patients the median [IQR] number of auto-DAS performed was 5.4 [1.7 – 12.8] overall, i.e. 2.3 [0.8 – 5.9] per year. However among the adherent population, the number of patients who completed their autoDAS booklet at least once per year decreased over time, with 351 (99%), 162 (46%) and 118 (33%) patients respectively for 2012, 2013 and 2014 (p<0.0001). In the multivariate analysis, only larger inclusion centres were significantly associated to an adherent behaviour (OR [95% CI] 2.9 [2.0 – 4.1], p<0.0001).

Conclusion: After a short training, many of these long-standing, moderately active RA patients continued to perform an auto-DAS, though the performance of auto-DAS decreased over time in this cohort where patients did not receive any ongoing positive feedback on their auto-DAS. In the larger inclusions centres, autoDAS adherence was higher, perhaps related to more patient/physician interactions around autoDAS results. Self-assessment of disease activity is feasible in RA but positive reinforcement appears necessary. Further studies should analyse if outcomes are better for patients who self-assess.

Disclosure: L. Gossec, None; F. Foissac, None; M. Soubrier, None; A. Molto, None; F. Fayet, None; T. Bardin, None; F. Berenbaum, None; A. Cantagrel, None; M. H. Cerato, None; G. H. Chales, None; I. Chary-Valckenaere, None; B. Combe, None; E. Dernis Labous, None; L. Euller-Ziegler, None; R. M. Flipo, None; P. Gaudin, None; M. Gilson, None; S. Guis, None; X. Mariette, None; G. Mouterde, None; S. Pouplin, None; P. Richette, None; A. Saraux, None; T. Schaeverbeke, None; J. Sibilia, None; M. Dougados, None.

To cite this abstract in AMA style:

Gossec L, Foissac F, Soubrier M, Molto A, Fayet F, Bardin T, Berenbaum F, Cantagrel A, Cerato MH, Chales GH, Chary-Valckenaere I, Combe B, Dernis Labous E, Euller-Ziegler L, Flipo RM, Gaudin P, Gilson M, Guis S, Mariette X, Mouterde G, Pouplin S, Richette P, Saraux A, Schaeverbeke T, Sibilia J, Dougados M. Is the Self-Assessment of Disease Activity (auto-DAS28) By Patients a Feasible and Acceptable Measure over the Long Term in Rheumatoid Arthritis (RA)? Three-Year Follow-up of a Nurse-Led Program in 771 Patients with Established RA [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/is-the-self-assessment-of-disease-activity-auto-das28-by-patients-a-feasible-and-acceptable-measure-over-the-long-term-in-rheumatoid-arthritis-ra-three-year-follow-up-of-a-nurse-led-program-in-77/. Accessed .

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