Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose:
Patient reported outcomes in rheumatoid arthritis (RA) are validated tools that assess disease status, are easily administered and used as components of RA composite disease activity scores. Further, patient global score is a criterion for RA remission and recent data suggest a 5mm difference in patient (PT) and physician (MD) global scores significant. Ethnic Minority RA Consortium (EMRAC) is a clinical registry of disease characteristics collected in a “real-world” setting. We evaluated ethnic RA subsets for differences in and associations of PT and MD global scores.
Methods:
IRB consented patients enrolled in EMRAC were evaluated. In addition to PT and MD global scores, differences in PT/MD scores (PT-MD >5mm, >10 mm), socio-demographic data, pain scores, parameters of RA disease status (MDHAQ, TJC, SJC) and composite RA disease measures (RAPID3, CDAI, DAS28) were collected. Comparisons of baseline data amongst ethnic groups were analyzed, and correlations of PT, MD global scores and differences in PT/MD scores with years of education, pain, MD-HAQ, TJC/SJC, treatments (DMRAD, biologic) and composite scores in each ethnic group were evaluated.
Results:
Analyses of 625 EMRAC patients were performed [Table]. Mostly female, the mean age was 55.5 (16.2) yrs and African Americans (AA) were the majority. RAPID3 composite scores were significantly higher in Hispanics vs all ethnic groups. AA and Hispanics had significantly higher MD- HAQ, pain and PT global scores than Caucasians. Mean difference in PT-MD global scores was 1.5(2.8), but significantly greater in Hispanics and Others compared to AA and Caucasians [2.7(2.5), 2.1(2.6), vs 1.2(2.8), 1.4 (3.0), p=0.005, respectively]. Similarly, PT-MD global score differentials of >5mm and >10mm were more frequent in Hispanics (80,76%) and Others (70,60%), compared to ~50% in both AA and Caucasians, (p=0.004, p=0.01, respectively). In comparison to Caucasians, correlation of PT global scores with disease duration, pain and RAPID3 scores was significantly lower in AA. Age showed less correlation with PT global scores in AA than Hispanics, (p=0.002). Hispanics had the greatest correlation of MD global scores with TJC compared to AA (p=0.001) and Caucasians (p<0.001). While MD global scores correlated less with CDAI in Caucasians than in Hispanics, the RAPID3 showed less correlation in Caucasians vs Other, (p=0.004, p=0.006 respectively). The ESR correlated with MD global in Hispanics vs AA (p=0.004) and Other (p<0.001).
Conclusion: In a diverse ethnic RA cohort, significant differences in patient and physician global scores were found. Multiple contributors and confounders may account for these findings, and may vary amongst ethnic subsets. Patient input from multiple ethnic groups is imperative to identify relevant parameters of disease function and standardize patient reported outcomes in the definition of remission.
|
|
Total |
African-American |
Caucasian |
Hispanic |
Other† |
P-value |
|
N |
625 |
228 |
207 |
120 |
70 |
— |
|
Age (years) |
55.5 (16.2) |
59.0 (13.9) |
54.5 (18.5) |
53.5 (15.0) |
50.7 (15.7) |
<0.001 |
|
Duration (years) |
10.1 (10.0) |
10.5 (10.0) |
10.3 (10.8) |
8.8 (8.9) |
10.1 (9.6) |
0.464 |
|
Education (years) |
14.2 (3.5) |
13.6 (3.1) |
15.7 (2.9) |
12.5 (3.9) |
15.0 (3.6) |
<0.001 |
|
Female [N (%)] |
533 (85%) |
206 (90%) |
171 (83%) |
96 (80%) |
60 (86%) |
0.036* |
|
Patient Global [0-10] |
4.5 (2.9) |
4.6 (2.8) |
3.9 (2.8) |
5.3 (2.9) |
4.3 (3.3) |
0.002 |
|
MD Global [0-10] |
3.0 (2.3) |
3.4 (2.5) |
2.7 (2.0) |
2.7 (2.0) |
2.8 (2.0) |
0.176 |
|
Patient – MD Global [mm] |
|
|
|
|
|
|
|
Difference |
1.5 (2.8) |
1.2 (2.8) |
1.4 (3.0) |
2.7 (2.5) |
2.1 (2.6) |
0.005 |
|
> 5 |
232 (59%) |
109 (56%) |
57 (51%) |
36 (80%) |
30 (70%) |
0.004* |
|
> 10 |
213 (54%) |
100 (52%) |
53 (48%) |
34 (76%) |
26 (60%) |
0.010* |
|
RAPID3 [0-30] |
11.8 (7.2) |
12.5 (7.0) |
10.3 (6.9) |
13.7 (7.1) |
11.1 (8.0) |
0.001 |
|
CDAI [0-72] |
13.9 (12.3) |
13.7 (12.5) |
14.6 (11.2) |
10.8 (9.5) |
15.4 (14.2) |
0.216 |
|
DAS28 [0-10] |
3.9 (1.5) |
3.9 (1.5) |
3.8 (1.6) |
3.0 (1.9) |
4.2 (1.5) |
0.597 |
|
Treatment |
|
|
|
|
|
|
|
Prednisone [N (%)] |
241 (39%) |
107 (47%) |
66 (32%) |
44 (37%) |
24 (34%) |
0.010* |
|
DMARDS [N (%)] |
448 (72%) |
183 (80%) |
131 (63%) |
83 (69%) |
51 (73%) |
0.001* |
|
Biologics [N (%)] |
206 (33%) |
50 (22%) |
81 (39%) |
50 (42%) |
25 (36%) |
<0.001* |
|
† Asian and Pacific Islanders |
||||||
|
*N (%) and Chi-square reported. Otherwise, Mean (SD) and Kruskal-Wallis reported. |
||||||
Disclosure:
G. S. Kerr,
Genentech and Biogen IDEC Inc.,
2;
Y. Yazici,
BMS, Genentech, Abbott, Merck, Pfizer, UCB, Celgene, Horizon,
5;
C. J. Swearingen,
None;
L. R. Espinoza,
None;
E. L. Treadwell,
None;
Y. R. S. Sherrer,
U.C.B.,
2,
AstraZeneca,
2,
lilly,
2,
Merck Pharmaceuticals,
2,
Amgen,
8;
A. D. Mosley-Williams,
None;
A. Ince,
None;
R. G. Nair,
None;
T. Lawrence Ford,
Abbott Immunology Pharmaceuticals,
2,
Amgen,
2,
Centocor, Inc.,
2,
Genentech and Biogen IDEC Inc.,
2,
Lilly,
2,
Pfizer Inc,
2,
UCB,
2,
Abbott Immunology Pharmaceuticals,
8,
Amgen,
8,
Pfizer Inc,
8,
UCB,
8;
J. Huang,
None;
C. A. Nunziato,
None.
« Back to 2012 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/patient-versus-physician-global-assessments-in-ethnic-patients-wtih-rheumatoid-arthritis/