Amsterdam Rheumatology and immunology Center, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
Amsterdam Rheumatology and immunology Center, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands; Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
Semin Arthritis Rheum. 2021 Dec;51(6):1360-1369. doi: 10.1016/j.semarthrit.2021.07.005. Epub 2021 Jul 25.
Patients have identified pain, fatigue and independence as the most important domains that need to be improved to define remission in rheumatoid arthritis (RA). This study identified and validated instruments for these domains and evaluated their added value to the ACR/EULAR Boolean remission definition.
Patients with a 28-joint Disease Activity Score (DAS28) ≤3.2 or in self-perceived remission (declaring their disease activity 'as good as gone') from the Netherlands, Portugal, Australia, and Canada, were assessed at 0, 3 and 6 months for patient-reported outcomes and the WHO-ILAR RA core set. Instrument validity was evaluated cross-sectionally, longitudinally and for the ability to predict future good outcome in terms of physical functioning. Logistic regression quantified the added value to Boolean remission.
Of 246 patients, 152 were also assessed at 3, and 142 at 6 months. Most instruments demonstrated construct validity and discriminative capacity. Pain and fatigue were best captured by a simple numerical rating scale (NRS). Measurement of independence proved more complex, but a newly developed independence NRS was preferred. NRS for pain, fatigue and independence, in addition to or instead of patient global assessment did not add enough information to justify modification of the current Boolean definition of remission in RA.
Key elements of the patient perspective on remission in RA can be captured by NRS pain, fatigue, and independence. Although this study did not find conclusive evidence to improve the current definition of remission in RA, the information from these instruments adds value to the physician's assessment of remission and further bridges the gap between physician and patient.
患者已经确定疼痛、疲劳和独立性是类风湿关节炎（RA）缓解定义中需要改善的最重要领域。本研究确定并验证了这些领域的工具，并评估了它们对 ACR/EULAR 布尔缓解定义的附加价值。
来自荷兰、葡萄牙、澳大利亚和加拿大的 DAS28 评分≤3.2 或自我感知缓解（宣称其疾病活动“几乎消失”）的患者在 0、3 和 6 个月时进行患者报告的结果和 WHO-ILAR RA 核心组评估。使用横截面、纵向和预测未来身体功能良好结局的能力评估工具的有效性。逻辑回归量化了对布尔缓解的附加价值。
在 246 名患者中，有 152 名患者还在 3 个月时进行了评估，142 名患者在 6 个月时进行了评估。大多数工具都显示了结构有效性和鉴别能力。疼痛和疲劳最好用简单的数字评定量表（NRS）来衡量。独立性的测量更为复杂，但新开发的独立性 NRS 更为适用。疼痛、疲劳和独立性的 NRS，无论是作为患者整体评估的补充还是替代，都没有提供足够的信息来证明对 RA 目前的布尔缓解定义进行修改是合理的。
RA 患者对缓解的观点的关键要素可以通过 NRS 疼痛、疲劳和独立性来衡量。尽管本研究没有找到改善 RA 缓解定义的确凿证据，但这些工具的信息增加了医生对缓解的评估价值，并进一步缩小了医生和患者之间的差距。
