ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2099

Patient Self-Assessments and Selected Patient Reported Outcomes May Reliably Identify Rheumatoid Disease Flare in Early Rheumatoid Arthritis Patients

Vivian P. Bykerk1, Clifton O. Bingham III2, Ernest Choy3, Juan Xiong4, Gilles Boire5, Carol A. Hitchon6, Janet E. Pope7, J. Carter Thorne8, Boulos Haraoui9, Edward Keystone10 and Susan J. Bartlett11, 1Rheumatology, Hospital for Special Surgery, New York, NY, 2Rheumatology, Johns Hopkins University, Baltimore, MD, 3Section of Rheumatology, Cardiff University School of Medicine, Cardiff, United Kingdom, 4Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada, 5Rheumatology Division, Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC, Canada, 6University of Manitoba, Winnipeg, MB, Canada, 7Medicine/Rheumatology, St. Joseph Health Care London, University of Western Ontario, London, ON, Canada, 8Southlake Regional Health Centre, Newmarket, ON, Canada, 9Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada, 10University of Toronto, Toronto, ON, Canada, 11Clinical Epidemiology, McGill University, Montreal, QC, Canada

Meeting: ACR/ARHP Annual Meeting 2012

Keywords:

Session Information

Title: Rheumatoid Arthritis - Clinical Aspects III: Infections/Risk Factors for Incident Rheumatoid Arthritis/Metrology/Classification/Biomarkers/Predictors of Rheumatolid Arthritis Activity & Severity

Session Type: Abstract Submissions (ACR)

Background/Purpose: Significant RA worsening or flare may predict poorer outcomes and signal a need for treatment reassessment. However, there is little agreement about how to reliably identify a flare. Candidate domains essential for assessing RA flare were identified by OMERACT patients (pts)and health care providers including pain, function, stiffness, participation, coping, patient global assessment, fatigue and self-management1. We aimed to determine the extent of agreement between pts and treating rheumatologists (MD) in identifying a flare, and concordance of clinical and patient-reported outcomes (PROs) with flare status.

Methods: Pts in the Canadian early ArThritis CoHort (CATCH) completed the OMERACT preliminary flare questionnaire (PFQ). In the PFQ pts were asked if they were in a flare and to rate severity, pain, function, stiffness, participation, coping, patient global assessment and fatigue (0-10 NRS). Pts also identified tender and swollen joints (TJC and SJC)(42 joint homunculus). MDs rated if their patient (pt) was in a flare and performed a joint count. Pt-MD agreement on flare status was assessed using Cohen’s kappa. Wilcoxon rank sum test was used to compare MD and pt reported joint counts. Clinical indices and PROs between flare and non-flare pts were compared using paired t-tests.

Results: 512 pts (75% female) answered PFQ: 13% at baseline, 39% at 3-12 months and 49% at 12 months+ after study entry. Pts had a mean age of 53 ± 14 yrs; 18% were smokers, 63% RF+, 51% CCP+ and 18% had erosions. 149 (29%) reported a flare at study visits. Pts and MDs agreed about flare status 72% of the time (Kappa=0.34). Changes in DAS28 and CDAI from previous visits were higher in flare vs. non flare pts(0.44 vs. -0.14) (1.67 vs. -3.20) (both p<.0001). PROs were significantly different between flare and non-flare pts and were highest when pts and MDs both agreed the pt was in a flare (p<.0001) (see Table). Pts in a flare reported higher TJC/SJCs than MDs. The differences between pt and MD TJC & SJC were 3.74 (p<.0001) and 2.31 (p<.0004). Agreement was modest (Kappa=.32) when pts/MDs agreed on flare status but poor then they didn’t (Kappa=.20)

Table 1: Ratings of flare severity and PROs by Patient/MD concordance

 

Domain

Pt Flare /MD Flare(n=86)

Pt Flare /MD Non-Flare (n=63)

Pt Non Flare /MD Flare (n=83)

Pt Non Flare /MD Non Flare (n=280)

p-values

Flare severity

6.2 (2.4)

5.2 (2.6)

0.3 (1.5)

0.2 (0.8)

<.001

Pain

6.3 (2.4)

5.1 (2.7)

3.7 (2.6)

1.7 (1.9)

<.001

Function

6.2 (2.6)

4.1 (3.2)

3.7 (2.8)

1.3 (1.8)

<.001

Stiffness

5.8 (2.8)

4.3 (2.9)

3.7 (2.5)

1.7 (1.9)

<.001

Participation

5.6 (2.8)

3.8 (3.0)

3.4 (2.8)

1.2 (1.9)

<.001

Fatigue

5.6 (2.8)

4.7 (3.1)

4.1 (3.0)

2.0 (2.5)

<.001

Coping

4.8 (2.6)

3.2 (2.7)

3.1 (2.6)

1.1 (1.8)

<.001

Values are mean (SD)

 *Domains scored 0-10 on a numerical rating score, ascending by severity.

Conclusion: Pts reporting a flare have clinical indices reflecting worsening disease activity. PROs (pain, function, stiffness, coping, participation, and fatigue) significantly discriminated between pts reporting flare vs. no flare. There is modest agreement between pts and MDs regarding flare status. Flare pts identify more swollen and tender joints than MDs. PROs and pt-joint counts may reliably identify pts in disease flares but some ratings are higher in pts than MDs. More research is needed to identify predictors of concordance and discrepancy between pts and providers in flare assessment.

 References: 1Bartlett SJ, et al. ArthRheum 2011;63(suppl):128.

Disclosure:

V. P. Bykerk,
None;

C. O. Bingham III,

Genentech, Roche Pharmaceuticals,

5;

E. Choy,
None;

J. Xiong,
None;

G. Boire,
None;

C. A. Hitchon,
None;

J. E. Pope,
None;

J. C. Thorne,
None;

B. Haraoui,
None;

E. Keystone,

Amgen,

2,

Pfizer Inc,

2,

Hoffmann-La Roche, Inc.,

2,

United Chemicals of Belgium (UCB) Canada Inc.,

2,

Bristol-Myers Squibb,

2,

Abbott Laboratories,

2,

Janssen Inc.,

2;

S. J. Bartlett,
None.

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