Centro Hospitalar e Universitário de Coimbra and Health Sciences Research Unit: Nursing, Coimbra, Portugal.
Centro Hospitalar e Universitário de Coimbra and University of Coimbra, Coimbra, Portugal.
Arthritis Care Res (Hoboken). 2018 Mar;70(3):369-378. doi: 10.1002/acr.23284. Epub 2018 Jan 30.
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.
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.
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 (R = 0.50) by fatigue, pain, anxiety, and function. Fatigue and pain had no relationship with disease activity measures.
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.
在类风湿关节炎（RA）的当前管理模式中，患者整体评估（PGA）对于确定患者是否达到缓解（目标）或需要强化治疗至关重要。我们研究了 PGA 的临床和心理决定因素是否适合支持这一重要作用。
这是一项横断面、单中心研究，纳入了连续的门诊 RA 患者。数据收集包括肿胀 28 关节计数（SJC28）、压痛 28 关节计数（TJC28）、C 反应蛋白（CRP）水平、PGA、疼痛、疲劳、功能、焦虑、抑郁、幸福感、人格特质和合并症。缓解使用美国风湿病学会/欧洲抗风湿病联盟基于布尔的标准进行分类：缓解、接近缓解（仅 PGA>1）和未缓解。还研究了没有 PGA 的二分类定义（3v-缓解）。使用单变量和多变量分析来确定每个缓解状态下 PGA 的解释变量。
共纳入 309 例患者（缓解率 9.4%，接近缓解率 37.2%，未缓解率 53.4%）。接近缓解的患者在疾病活动度方面与缓解患者无法区分，但描述的疾病影响与未缓解患者相似。多变量分析显示，接近缓解患者的 PGA 由疲劳、疼痛、焦虑和功能解释（R=0.50）。疲劳和疼痛与疾病活动度测量无关。
在 RA 中，公认可接受的疾病活动水平（SJC28、TJC28 和 CRP 水平≤1）并不等同于低疾病影响：很大一部分患者仅因 PGA 而被认为处于未缓解状态。PGA 主要反映疲劳、疼痛、功能和心理领域，这些不足以确定免疫抑制治疗的目标。这种考虑表明，临床实践应该由两个单独的缓解目标指导：炎症（3v-缓解）和疾病影响。
