Background/Purpose: The patients with rheumatoid arthritis (RA) often do not meet patient global assessment (PGA) remission criterion despite a good clinical disease state and, therefore, PGA is not solely influenced by RA disease activity. It has been reported that PGA is a limiting factor for reaching remission. We evaluated whether psychological state influences on Boolean-based definition of PGA remission for patients with RA.
Methods: The patients with RA (n=112) were recruited. Disease activity was evaluated with swollen joint counts (SJC) and tender joint counts (TJC) and evaluator’s global assessment (EGA), PGA, and patient pain (Pain VAS) were assessed with visual analog scale. Depression and anxiety were examined utilizing the Hospital Anxiety and Depression Scale-Depression (HADS-D) and the State-Trait Anxiety Inventory (STAI), respectively. General health status was evaluated with Sort Form-36 (SF-36). Comparison analyses were performed between remission group (VAS=<1cm) and non-remission group (VAS>1cm) in PGA, EGA, and pain VAS. Data analyses were performed utilizing Wilcoxon rank-sum test and Spearman correlation analysis.
Results: There was no significant difference in age, duration and PSL dosage between PGA remission group (n=35) and non-remission group (n=77) or EGA remission group (n=38) and non-remission group (n=74). SJC and TJC of remission groups were significantly lower in PGA and EGA (p<0.0001, p<0.0001, respectively). Among TJC, SJC and pain VAS, PGA was most significantly related to pain VAS (r=0.9232, p<0.0001), while EGA was related to SJC (r=0.7725, p<0.0001). STAI (State) and HADS-D were significantly lower in pain VAS remission group (p=0.0018, p=0.0005, respectively). STAI (State) was significantly lower in PGA remission group (p<0.05), while no significant difference was found between two groups in EGA (p=0.2463). Similarly in HADS-D, the number of patients with depression was significantly fewer in PGA remission group (p<0.05), while no significant difference was found between two groups in EGA (p=0.2522). In SF-36, all of the eight components improved significantly in PGA remission group. There was no significant difference in mental health between two groups in EGA (p=0.1602). PGA is related to pain VAS, in contrast EGA is related to SJC. The patients with pain VAS remission are less depressive and less anxious. The patients with PGA remission have depression or anxiety less than those with PGA non-remission. Moreover, mental health of SF-36 was significantly better in PGA remission group. On the contrary, there is no significant difference in anxiety, depression and mental health of SF-36 between two groups in EGA.
Conclusion: Discrepancy between PGA and EGA, which is supposed to reflect disease activity of RA, may be partially explained by the difference in psychological state, and support for psychological state may be effective for improvement of PGA. At present, clinical, radiological and functional remissions have been proposed as goal of treatment of RA. As PGA remission is a limiting factor for Boolean remission and PGA relates to psychological state, psychological remission might be important to attain true remission.
Disclosure:
M. Fusama,
None;
K. Yukioka,
None;
T. Kuroiwa,
None;
C. Yukioka,
None;
M. Inoue,
None;
T. Nakanishi,
None;
N. Murata,
None;
N. Takai,
None;
K. Higashi,
None;
T. Kuritani,
None;
K. Maeda,
None;
Y. Miura,
None;
H. Sano,
None;
M. Yukioka,
None;
H. Nakahara,
None.
« Back to 2013 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/support-for-psychological-state-may-be-effective-to-attain-remission-of-boolean-based-definition-of-patient-global-assessment-in-patients-with-rheumatoid-arthritis/