Centro Hospitalar e Universitário de Coimbra, and Nursing School of Coimbra, Coimbra, Portugal.
Centro Hospitalar e Universitário do Algarve, Faro, Portugal.
Arthritis Care Res (Hoboken). 2019 Oct;71(10):1317-1325. doi: 10.1002/acr.23866.
There is an ongoing debate about excluding patient's global assessment (PtGA) from composite and Boolean-based definitions of rheumatoid arthritis (RA) remission. This study aimed at determining the influence of PtGA on RA disease states, exploring differences across countries, and understanding the association between PtGA, measures of disease impact (symptoms), and markers of disease activity (inflammation).
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 PtGA (PtGA-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 PtGA, 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).
This study included 27,768 patients. Excluding PtGA from the Boolean-based definition (3-variable remission) increased the remission rate from 5.8% to 15.8%. The rate of PtGA-near-remission varied considerably between countries, from 1.7% in India to 17.9% in Portugal. One-third of the patients in PtGA-near-remission group scored PtGA >4 of 10. Pain and function were the main correlates of PtGA, with inflammation-related variables contributing less to the model (R = 0.57).
PtGA 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 PtGA, putting them at risk of excessive immunosuppressive treatment.
关于将患者整体评估（PtGA）排除在类风湿关节炎（RA）缓解的综合和基于布尔的定义之外，目前存在争议。本研究旨在确定 PtGA 对 RA 疾病状态的影响，探索不同国家之间的差异，并了解 PtGA、疾病影响措施（症状）和疾病活动标志物（炎症）之间的关联。
使用来自治疗疗效评估在风湿病学新时代国际数据库的横断面数据。我们计算了在整个样本中和在最具代表性的国家（即数据库中患者超过 3000 人的国家）中，仅由于 PtGA 而导致美国风湿病学会/欧洲抗风湿病联盟基于布尔的缓解（4 变量缓解）失败的患者比例（PtGA 接近缓解）。使用多变量线性回归模型确定 PtGA 的主要决定因素，分为主要炎症影响因素（28 个压痛关节计数、28 个肿胀关节计数和 C 反应蛋白水平）和疾病影响因素（疼痛和功能）。
本研究纳入了 27768 名患者。将 PtGA 排除在基于布尔的定义（3 变量缓解）之外，可将缓解率从 5.8%提高到 15.8%。PtGA 接近缓解的比例在不同国家之间差异很大，从印度的 1.7%到葡萄牙的 17.9%。在 PtGA 接近缓解组中，三分之一的患者 PtGA 评分>10 分中的 4 分。疼痛和功能是 PtGA 的主要相关因素，炎症相关变量对模型的贡献较小（R=0.57）。
PtGA 与总体关节炎症中度相关，但在疾病活动度较低时相关性较弱。相当一部分原本处于生物缓解的患者仍存在较高的 PtGA，使他们面临过度免疫抑制治疗的风险。
