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Suppressing Inflammation in Rheumatoid Arthritis: Does Patient Global Assessment Blur the Target? A Practice‐Based Call for a Paradigm Change

Ferreira, Ricardo J. O. ; Duarte, Cátia ; Ndosi, Mwidimi ; Wit, Maarten ; Gossec, Laure ; Silva, J. A. P.

Arthritis care & research (2010), 2018-03, Vol.70 (3), p.369-378 [Periódico revisado por pares]

United States: Wiley Subscription Services, Inc

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  • Título:
    Suppressing Inflammation in Rheumatoid Arthritis: Does Patient Global Assessment Blur the Target? A Practice‐Based Call for a Paradigm Change
  • Autor: Ferreira, Ricardo J. O. ; Duarte, Cátia ; Ndosi, Mwidimi ; Wit, Maarten ; Gossec, Laure ; Silva, J. A. P.
  • Assuntos: Anxiety ; Fatigue ; Human health and pathology ; Immunosuppressive agents ; Life Sciences ; Mental depression ; Pain ; Patients ; Remission ; Rheumatoid arthritis ; Rheumatology ; Rhumatology and musculoskeletal system
  • É parte de: Arthritis care & research (2010), 2018-03, Vol.70 (3), p.369-378
  • Notas: ObjectType-Article-2
    SourceType-Scholarly Journals-1
    ObjectType-Undefined-1
    ObjectType-Feature-3
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  • Descrição: Objective In current management paradigms of rheumatoid arthritis (RA), patient global assessment (PGA) is crucial to decide whether a patient has attained remission (target) or needs reinforced therapy. We investigated whether the clinical and psychological determinants of PGA are appropriate to support this important role. Methods This was a cross‐sectional, single‐center study including consecutive ambulatory RA patients. Data collection comprised swollen 28‐joint count (SJC28), tender 28‐joint count (TJC28), C‐reactive protein (CRP) level, PGA, pain, fatigue, function, anxiety, depression, happiness, personality traits, and comorbidities. Remission was categorized using American College of Rheumatology/European League Against Rheumatism Boolean‐based criteria: remission, near‐remission (only PGA >1), and nonremission. A binary definition without PGA (3v‐remission) was also studied. Univariable and multivariable analyses were used to identify explanatory variables of PGA in each remission state. Results A total of 309 patients were included (remission 9.4%, near‐remission 37.2%, and nonremission 53.4%). Patients in near‐remission were indistinguishable from remission regarding disease activity, but described a disease impact similar to those in nonremission. In multivariable analyses, PGA in near‐remission was explained (R2adjusted = 0.50) by fatigue, pain, anxiety, and function. Fatigue and pain had no relationship with disease activity measures. Conclusion In RA, a consensually acceptable level of disease activity (SJC28, TJC28, and CRP level ≤1) does not equate to low disease impact: a large proportion of these patients are considered in nonremission solely due to PGA. PGA mainly reflects fatigue, pain, function, and psychological domains, which are inadequate to define the target for immunosuppressive therapy. This consideration suggests that clinical practice should be guided by 2 separate remission targets: inflammation (3v‐remission) and disease impact.
  • Editor: United States: Wiley Subscription Services, Inc
  • Idioma: Inglês
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  • Realização: ABCD-USP USP   Logos de Redes Sociais: Freepik

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