Session Information
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose:
Patient reported outcomes (PROs) are important for evaluation of treatment response in patients with rheumatoid arthritis (RA). Ultrasound (US) is a sensitive method for assessing inflammation, including grey scale synovitis (GS) and vascularization (power Doppler (PD)). The present objective was to explore the associations during biologic treatment between subjective evaluations of disease activity and more objective assessments of inflammation including US.
Methods:
93 patients with RA (mean (SD) age 50 (13) years, disease duration 8 (7) years, 77% women, 76% anti-CCP positive) were included when starting etanercept 50 mg/week (79% biologic naïve, 54% using prednisolone). The patients were assessed at baseline and after 1, 2, 3, 6 and 12 months with PROs (joint pain VAS, patient’s global disease activity VAS, Rheumatoid Arthritis (RA) Impact of Disease (RAID) score, MHAQ), clinical examination (assessor’s disease activity VAS, tender and swollen joints (of 32) performed by a study nurse) and laboratory variables (ESR and CRP). DAS28 and CDAI were calculated. Pain catastrophizing was assessed by the sum of two questions from the Coping Strategies Questionnaire (CSQ, score 0-6) and Swollen/Tender Ratio of 28 joints (STR) was calculated to assess the pain component of arthritis. All US examinations (semi-quantitative scoring (0-3) of GS and PD (PIP 2-3, MCP 1-5, wrist (RC, IC, RU), elbow, knee, talo-crural, MTP 1-5 and ECU/TP tendons bilaterally) were performed by one rheumatologist (HBH) (Siemens Acuson Antares, excellence version, 5-13 MHz probe, optimized settings). Last observation carried forward was used for missing data. Correlations were explored by use of Spearman’s, Wilcoxon explored changes from baseline and Mann-Whitney examined differences between two independent groups.
Results:
The 62 patients fulfilling 12 months treatment showed decrease in all variables during the study (p≤0.001, table). The correlations between patient’s global VAS and number of swollen joints, ESR, CRP and US sum scores were low during the study (median (range) r= 0.13 (0.00-0.33). Patients with pain catastrophizing (score 3-12) and low STR (<1.0) had significantly higher subjective variables, but there were no different objective assessments of disease activity (table).
Conclusion:
Subjective evaluations of disease activity were weakly associated with objective assessments of inflammation. Patients with catastrophizing and low STR may not reach DAS28 remission in spite of objectively decreased disease activity. The different expression of pain and PRO scoring in these patients should be acknowledged during biologic treatment.
|
|
Baseline, median (range) |
1 month, median (range) |
2 months, median (range) |
3 months, median (range) |
6 months, median (range) |
12 months, median (range) |
|
Joint pain |
33 (11-57) |
14 (5-32) |
14 (5-25) |
8 (2-24) |
9 (3-22) |
8 (4-25) |
|
Patient global VAS |
45 (20-66) |
14 (9-32) |
14 (4-30) |
15 (2-29) |
14 (3-28) |
11 (4-36) |
|
Sum score RAID |
3,8 (2.2-5.3) |
2.2 (1.0-3.7) |
1.9 (0.9-3.4) |
1.7 (0.7-3.2) |
1.8 (0.8-3.4) |
2.1 (0.5-4.0) |
|
Sum score catastrophizing |
4 (2-6) |
2 (0-5) |
2 (0-4) |
2 (0-4) |
2 (0-4) |
2 (0-4) |
|
MHAQ |
0.38 (0.13-0.88) |
0.13 (0-0.38) |
0.13 (0-0.38) |
0.13 (0-0.38) |
0.13 (0-0.35) |
0.07 (0-0.38) |
|
DAS28 |
4.1 (3.1-4.8) |
3.2 (2.5-4.2) |
3.0 (2.2-4.0) |
3.0 (2.0-3.8) |
2.8 (2.0-3.5) |
2.6 (1.9-3.5) |
|
Tender joints (of 32) |
4 (1-9) |
3 (1-6) |
2 (0-6) |
1 (0-5) |
1 (0-4) |
1 (0-3) |
|
Swollen joint (of 32) |
5 (3-9) |
4 (2-7) |
3 (1-6) |
2 (0-6) |
2 (0-4) |
1 (0-3) |
|
Assessor’s global VAS |
25 (15-35) |
19 (10-25) |
15 (10-22) |
12 (5-20) |
11 (8-18) |
12 (6-19) |
|
Sum score GS |
28 (18-40) |
22 (14-32) |
21 (12-34) |
18 (10-28) |
17 (10-23) |
16 (10-23) |
|
Sum score PD |
10 (4-22) |
7 (2-16) |
4 (2-16) |
4 (1-11) |
3 (1-8) |
3 (1-7) |
|
|
Not catastrophizers (score 0-2) / Catastrophizers (score 3-12) (median (p value)) |
Number of patients Swollen/Tender count Ratio ≥ 1.0 / <1.0 (median (p value)) |
||||||||||
|
|
Baseline |
1 month |
2 months |
3 months |
6 months |
12months |
Baseline |
1 month |
2 months |
3 months |
6 months |
12 months |
|
No patients |
30 / 63 |
40 / 51 |
46 / 39 |
48 /37 |
43 / 30 |
41 / 21 |
60 / 33 |
68 / 24 |
59/26 |
62/24 |
48/25 |
42/19 |
|
Joint pain VAS |
10 / 51 (p<0.001) |
9 / 29 (p<0.001) |
7 / 28 (p<0.001) |
5 / 25 (p<0.001) |
5 / 22 (p<0.001) |
5 / 27 (p<0.001) |
32/ 51 (NS) |
12/34 (p<0.001) |
10/28 (p=0.001) |
7/26 (p<0.001) |
7/22 (p=0.001) |
5/24 (p=0.004) |
|
Patient’s global VAS |
22 /56 (p<0.001) |
10 / 25 (p<0.001) |
8 / 30 (p<0.001) |
7 / 31 (p<0.001) |
7 / 27 (p<0.001) |
6 / 32 (p<0.001) |
45/61 (p=0.008) |
12/29 (p=0.001) |
10/34 (p<0.001) |
8/30 (p<0.001) |
10/20 (p0.009) |
7/27 (p=0.016) |
|
Sum score RAID |
2.4 / 5.1 (p<0.001) |
1.1 / 3.5 (p<0.001) |
1.2 / 3.2 (p<0.001) |
1.2 / 3.3 (p<0.001) |
1.3 / 3.5 (p<0.001) |
0.9 / 4.0 (p<0.001) |
3.3 /5.3 (p=0.003) |
1.5/3.7 (p<0.001) |
1.5/3.6 (p<0.001) |
1.2/3.4 (p<0.001) |
1.8/2.8 (p=0.049) |
0.9/3.4 (p=0.001) |
|
MHAQ |
0.25 0.75 (p<0.001) |
0.00/0.38 (p<0.001) |
0.00/0.38 (p<0.001) |
0.00 /0.25 (p<0.001) |
0.00/0.25 (p=0.001) |
0.00/0.38 (p=0.001) |
0.38/0.75 (NS) |
0.00/0.38 (p<0.001) |
0.12/0.38 (p=0.005) |
0.00/0.38 (p<0.001) |
0.07/0.25 (NS) |
0.00/0.38 (p=0.002) |
|
DAS28 (ESR) |
3.3 / 4.6 (p<0.001) |
2.7 / 3.8 (p =0.003) |
2.4 / 3.8 (p<0.001) |
2.6 / 3.8 (p<0.001) |
2.5 / 3.5 (p=0.009) |
2.2 / 3.6 (p<0.001) |
3.9/ 5.1 (p<0.001) |
2.9/4.2 (p<0.001) |
2.6/4.1 (p<0.001) |
2.7/4.1 (p<0.001) |
2.4/3.5 (p<0.001) |
2.3/3.6 (p<0.001) |
|
CDAI |
11 / 16 (p<0.001) |
8 / 11 (p=0.03) |
5 / 12 (p=0.001) |
5 / 11 (p<0.001) |
6 /9 (p=0.003) |
4 / 9 (p=0.002) |
13/20 (p=0.008) |
8/13 (p=0.003) |
6/15 (p<0.001) |
6/11 (p<0.001) |
6/9 (p=0.001) |
4/10 (p=0.001) |
|
No tender joints (of 32) |
3 / 5 (p=0.034) |
2 / 5 (p=0.001) |
1 / 6 (p<0.001) |
1 / 3 (p=0.018) |
1 / 3 (NS) |
0 / 3 (p=0.001) |
3/10 (p<0.001) |
2/7 (p<0.001) |
1/8 (NS) |
1/8 (p<0.001) |
1/5 (p<0.001) |
0/5 (p<0.001) |
|
No swollen joints (of 32) |
4 / 5 (NS) |
4 / 3 (NS) |
3 / 3 (NS) |
2 / 3 (NS) |
1 / 2 (NS) |
1 / 2 (NS) |
5 /4 (NS) |
4/3 (NS) |
3/3 (NS) |
2/2 (NS) |
2/2 (NS) |
1/2 (NS) |
|
Assessor’s global VAS |
22 / 25 (p=0.028) |
15 / 17 (NS) |
15 / 17 (NS) |
10 / 18 (p=0.001) |
10 / 17 (p=0.015) |
10/15 (p=0.016) |
25/25 (NS) |
15/16 (NS) |
15/18 (NS) |
11/14 (NS) |
10/14 (NS) |
11/15 (NS) |
|
ESR |
16 / 23 (p=0.041) |
14 / 13 (NS) |
11 / 14 (NS) |
15 / 18 (NS) |
11 / 15 (NS) |
10 / 16 (NS) |
21/20 (NS) |
13/13 (NS) |
12/11 (NS) |
16/17 (NS) |
12/12 (NS) |
13/14 (NS) |
|
CRP |
3/ 5 (NS) |
2 / 2 (NS) |
1 / 2 (NS) |
2 / 2 (NS) |
1 / 3 (p=0.044) |
1 / 1 (NS) |
4 /5 (NS) |
2/2 (NS) |
1 /2 (NS) |
2/2 (NS) |
2/2 (NS) |
1/2 (NS) |
|
Sum score GS |
27 / 26 (NS) |
21 / 20 (NS) |
20 / 15 (NS) |
17 / 17 (NS) |
17 / 18 (NS) |
16 / 16 (NS) |
28/19 (NS) |
23/18* (p=0.041) |
20/17 (NS) |
20/14 (NS) |
17/16 (NS) |
16/16 (NS) |
|
Sum score PD |
9 / 8 (NS) |
5 / 5 (NS) |
5 / 3 (NS) |
4 / 5 (NS) |
3 / 3 (NS) |
3 / 3 (NS) |
11/6 (NS) |
7/2* (p=0.009) |
5/3 (NS) |
4/2 (NS) |
3/3 (NS) |
4/3 (NS) |
To cite this abstract in AMA style:
Hammer HB, Lampa J. The Patients Evaluation of Pain and Disease Activity As Well As Improvement during One-Year Follow-up on Etanercept Treatment Is Highly Associated to Subjective Factors and Not to Objective Assessments Including Ultrasound [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/the-patients-evaluation-of-pain-and-disease-activity-as-well-as-improvement-during-one-year-follow-up-on-etanercept-treatment-is-highly-associated-to-subjective-factors-and-not-to-objective-assessment/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-patients-evaluation-of-pain-and-disease-activity-as-well-as-improvement-during-one-year-follow-up-on-etanercept-treatment-is-highly-associated-to-subjective-factors-and-not-to-objective-assessment/