Session Information
Title: Rheumatoid Arthritis - Clinical Aspects (ACR): Comorbidities, Treatment Outcomes and Mortality
Session Type: Abstract Submissions (ACR)
Background/Purpose: Understanding patient’s perspective of minimally clinically important difference (MCID) in health (or disease) status is important to improve patient-centered clinical care and planning and interpretation of clinical trial results. The aim of this study was to estimate mean changes in patient reported outcomes (PROs) and a PRO-based composite index [Routine Assessment of Patient Index Data 3 (RAPID3)] and assess the impact of comorbidities on MCID in rheumatoid arthritis (RA) patients.
Methods: A retrospective study of RA patients receiving routine clinical care at a single academic center from 2009 to 2012 was conducted. Eligibility criteria were a board-certified Rheumatologist diagnosed RA and ≥ 2 Rheumatology clinic visits. A patient completed questionnaire is part of routine clinical practice and includes patient’s global impression of change compared to their last Rheumatology clinic visit on a 5-point Linkert scale (much better, somewhat better, about the same, somewhat worse, much worse). Data on socio-demographics; RA characteristics; PROs [functional status by Multi-Dimensional Health Assessment Questionnaires (MDHAQ); pain, patient’s global assessment (PTGL) by 21-point Numeric Rating Scale; RAPID3; and comorbidities were extracted in standardized manner from medical records. Comorbidity burden was quantified by a composite comorbidity score (range: 0-9) 1 and categorized as low (0-1), moderate (2-3) and high (>3). Random effects analysis of variance models were used to assess the association between change in disease characteristics and PGIC classification. Since each subject may have multiple observations in the data, a random effects term was included to account for the correlation among observations from the same subject.
Results: Data on 155 patients [125 (80.6%) females; 112 (72.3%) white; median (interquartile range, IQR) age of 58 (50-66) years; RA duration 6 (1.4-9.8) years; seropositive 76.5%] were available for analysis. 46 (29.7%), 64 (41.3%), and 45 (29%) patients had low, moderate and high comorbidity burden respectively. Table shows the estimated mean of the study measures. Negative values means improvement in scores compared to prior Rheumatology visits. For each PRO and RAPID3 there was strong interaction with comorbidity burden. In general patients with low comorbidity burden have higher threshold for change for MCID than those with moderate to high comorbidity burden (Table).
Conclusion: Comorbidities have strong influence on RA patient’s assessment of change of their health status. Comorbidities need to be considered when interpreting MCID.
|
|
Somewhat better |
About the same |
Somewhat worse |
|
MDHAQ (0-10) * Low comorbidity burden Moderate comorbidity burden High comorbidity burden |
-0.51 -0.43 -0.79 |
0.09 -0.36 -0.34 |
2.45 0.73 -0.31 |
|
Pain (0-10)* Low comorbidity burden Moderate comorbidity burden High comorbidity burden |
-1.82 -0.34 -0.35 |
0.64 -0.43 -0.13 |
1.95 0.87 0.41 |
|
PTGL (0-10)* Low comorbidity burden Moderate comorbidity burden High comorbidity burden |
-0.51 -0.43 -0.79 |
0.09 -0.36 -0.34 |
2.45 0.73 -0.31 |
|
RAPID3 (0-30) * Low comorbidity burden Moderate comorbidity burden High comorbidity burden |
-2.85 -1.81 -1.15 |
0.76 -0.97 -0.62 |
4.43 1.94 0.24 |
* P value < 0.001 for interaction of the variable with comorbidity burden.
Disclosure:
P. Bansal,
None;
A. Kaur,
None;
H. Spencer,
None;
N. A. Khan,
None.
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