Rheumatoid arthritis

Patient reported outcomes don’t improve definition of RA remission

Patient-perceived measures of pain, fatigue and independence do not add sufficient additional value to the current ACR/EULAR definition of remission in rheumatoid arthritis.

An international study, by the OMERACT Working Group on the Patient Perspective on Remission in RA, tested multiple measures in 246 patients across the Netherlands, Portugal, Australia and Canada at baseline, 3 months and 6 months.

Patients were in self-perceived remission at baseline or had low disease activity as defined by a Disease Activity Score of 28 joints (DAS28) ≤3.2.

An analysis of the results, published in Seminars in Arthritis & Rheumatism, showed all instruments including numerical rating scales (NRS) of pain, fatigue and functional disability were feasible and correlated moderately with disease activity.

“All instruments detected clinically relevant and significant differences between patients in remission and patients not in remission, for patient self-perceived remission as well as for ACR/EULAR remission,” the study said.

Most instruments were also shown to be sensitive to change and stability in disease state over time.

However, the addition of the new instruments to the ACR/EULAR definition of remission only provided incremental value.

“In our opinion, the analyses in this study did not provide sufficiently convincing data to recommend a modification of the current definition of remission, either by adding or by replacing instruments.”

The study, co-authored by Professors Susanna Proudman and Catherine Hill from South Australia, concluded that adding criteria to the definition would make it harder for patients to be classified as being in remission.

“Nevertheless, there is still need for a solution for the insufficient patient information in the current remission definition.”

“Future research could be done by identifying domains that predict future good outcome in terms of radiological progression over a 12-month period, as this was not possible within this study.”

The authors also noted that the low progression rates currently seen in practice make the studies challenging.

“Future data collection should include NRSs on pain, fatigue and independence to further bridge the gap between the physician’s and the patient’s perspective on remission,” they concluded.

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