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Impact of Patient's Global Assessment on Achieving Remission in Patients With Rheumatoid Arthritis: A Multinational Study Using the METEOR Database
Author(s) -
Ferreira Ricardo J. O.,
Carvalho Pedro David,
Ndosi Mwidimi,
Duarte Cátia,
Chopra Arvind,
Murphy Elizabeth,
Heijde Désirée,
Machado Pedro M.,
Silva José A. P.
Publication year - 2019
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.23866
Subject(s) - medicine , rheumatoid arthritis , rheumatology , rheumatism , disease , database , computer science
Objective There is an ongoing debate about excluding patient's global assessment (Pt GA ) from composite and Boolean‐based definitions of rheumatoid arthritis ( RA ) remission. This study aimed at determining the influence of Pt GA on RA disease states, exploring differences across countries, and understanding the association between Pt GA , measures of disease impact (symptoms), and markers of disease activity (inflammation). Methods Cross‐sectional data from the Measurement of Efficacy of Treatment in the Era of Outcome in Rheumatology international database were used. We calculated the proportion of patients failing American College of Rheumatology/European League Against Rheumatism Boolean‐based remission (4‐variable remission) solely due to Pt GA (Pt GA ‐near‐remission) in the overall sample and in the most representative countries (i.e., those with >3,000 patients in the database). Multivariable linear regression models were used to identify the main determinants of Pt GA , grouped in predominantly inflammatory impact factors (28 tender joint counts, 28 swollen joint counts, and C‐reactive protein level) and disease impact factors (pain and function). Results This study included 27,768 patients. Excluding Pt GA from the Boolean‐based definition (3‐variable remission) increased the remission rate from 5.8% to 15.8%. The rate of Pt GA ‐near‐remission varied considerably between countries, from 1.7% in India to 17.9% in Portugal. One‐third of the patients in Pt GA ‐near‐remission group scored Pt GA >4 of 10. Pain and function were the main correlates of Pt GA , with inflammation‐related variables contributing less to the model (R 2 = 0.57). Conclusion Pt GA is moderately related to joint inflammation overall, but only weakly so in low levels of disease activity. A considerable proportion of patients otherwise in biologic remission still perceive high Pt GA , putting them at risk of excessive immunosuppressive treatment.