Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
Health Sciences Research Unit: Nursing (UICiSA:E), Escola superior de Enfermagem de Coimbra, Coimbra, Portugal.
Clin Rheumatol. 2018 Jul;37(7):1963-1969. doi: 10.1007/s10067-018-4063-9. Epub 2018 Mar 10.
Patient global assessment (PGA) is included in almost all rheumatoid arthritis (RA) composite disease activity indices and definitions of remission. However, different PGA formulations exist and are used interchangeably in research and clinical practice. We investigated how five different PGA formulations used in four disease indices affect the remission rates. This was an ancillary analysis of data from a cross-sectional study in patients with RA. The data comprised the following: 28-joint counts, C-reactive protein, and five PGA formulations. Remission rate variation was assessed using five PGA formulations in each index (ACR/EULAR Boolean, CDAI, SDAI, and DAS28-CRP). PGA agreement was assessed by the following: Pearson's correlation; Bland-Altman plots; paired samples t test; and establishing the proportion of patients who scored (i) all formulations within an interval of 20 mm and (ii) each formulation ≤ 10 mm. This analysis included 191 patients. PGA formulations presented good correlations (≥ 0.65), but Bland-Altman plots showed clinically significant differences, which were statistically confirmed by comparison of means. Just over a half (51.8%) of patients scored all PGA formulations within a 20-mm interval. The proportion of those scoring ≤ 10 mm varied from 11.5 to 16.2%. When different formulations of PGA were used in each index, remission differences of up to 4.7, 4.7, 6.3, and 5.2% were observed. When formulations were used in their respective indices, as validated, the remission rates were similar (13.1, 13.6, 14.1, and 18.3%). Using PGA formulations interchangeably may have implications in the assessment of disease activity and in the attainment of remission, and this can impact upon management decisions.
患者整体评估（PGA）几乎包含在所有类风湿关节炎（RA）综合疾病活动指数和缓解定义中。然而，不同的 PGA 公式存在，并在研究和临床实践中互换使用。我们研究了在四个疾病指数中使用的五种不同的 PGA 公式如何影响缓解率。这是对 RA 患者横断面研究数据的辅助分析。数据包括以下内容：28 个关节计数、C 反应蛋白和五种 PGA 公式。使用每个指数中的五种 PGA 公式（ACR/EULAR 布尔、CDAI、SDAI 和 DAS28-CRP）评估缓解率变化。通过以下方法评估 PGA 一致性：Pearson 相关系数；Bland-Altman 图；配对样本 t 检验；以及确定评分（i）所有公式在 20mm 间隔内和（ii）每个公式≤10mm 的患者比例。该分析包括 191 名患者。PGA 公式呈现出良好的相关性（≥0.65），但 Bland-Altman 图显示出临床显著差异，通过均值比较可以得到统计学确认。超过一半（51.8%）的患者在 20mm 间隔内所有 PGA 公式的评分都在范围内。评分≤10mm 的患者比例在 11.5%至 16.2%之间变化。当在每个指数中使用不同的 PGA 公式时，观察到缓解率差异高达 4.7%、4.7%、6.3%和 5.2%。当在各自的指数中使用公式时，如验证的那样，缓解率相似（13.1%、13.6%、14.1%和 18.3%）。互换使用 PGA 公式可能会对疾病活动的评估和缓解的实现产生影响，从而影响管理决策。
