Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
Faculty of Medicine, University of Oslo, Oslo, Norway.
RMD Open. 2024 Sep 5;10(3):e004444. doi: 10.1136/rmdopen-2024-004444.
To explore the agreement between patient-reported flare status and clinically significant flare status in patients with rheumatoid arthritis (RA) in sustained remission.
Patients with RA in remission for ≥12 months on stable treatment were included in the ARCTIC REWIND tapering trials and pooled 12-month data used in current analyses. Patient-reported flare status was assessed according to the Outcome Measures in Rheumatology flare questionnaire; 'Are you having a flare of your RA at this time?' (yes/no). A clinically significant flare was defined as a combination of Disease Activity Score (DAS) >1.6, increase in DAS of ≥0.6 and 2 swollen joints, or the rheumatologist and patient agreed that a clinically significant flare had occurred. Agreement coefficient, sensitivity, specificity and predictive values of patient-reported flare status with regard to clinically significant flare status were determined.
Of 248 patients, 64% were women, age 56.1 (11.8) years, disease duration 4.1 (2.8-7.4) years, DAS 0.8 (0.3). 35% of patients reported a flare at least once, clinically significant flares were recorded in 21%. 48/53 clinically significant flares (91%) led to an intensification of disease-modifying antirheumatic drugss. In 621/682 (91%) visits, patient-reported and clinically significant flare status were in agreement, agreement coefficient 0.89. Sensitivity and specificity were both 91%, positive predictive value of patient-reported flare status 46% and negative predictive value 99%.
Among patients in sustained remission, patient-reported flare status was accurate in ruling out a clinically significant flare. About half of the patient-reported flares were assessed to be clinically significant. These findings support a potential for using patient-reported flare status in remote monitoring of patients with RA in sustained remission.
探索处于持续缓解状态的类风湿关节炎（RA）患者的患者报告的缓解状态与临床显著缓解状态之间的一致性。
纳入缓解期≥12 个月且稳定治疗的 RA 患者参加 ARCTIC REWIND 方案减量试验，并汇总目前分析中使用的 12 个月数据。根据风湿病学缓解指标的疾病活动度（DAS）缓解问卷评估患者报告的缓解状态；“您此时是否有 RA 发作？”（是/否）。临床显著缓解定义为 DAS>1.6，DAS 增加≥0.6 和 2 个肿胀关节，或风湿病医生和患者一致认为发生了临床显著缓解。确定患者报告的缓解状态与临床显著缓解状态之间的一致性系数、灵敏度、特异性和预测值。
248 例患者中，64%为女性，年龄 56.1（11.8）岁，病程 4.1（2.8-7.4）年，DAS 0.8（0.3）。35%的患者至少报告过一次发作，记录到 21%的临床显著发作。48/53 例临床显著发作（91%）导致疾病修饰抗风湿药物的强化。在 621/682（91%）次就诊中，患者报告的和临床显著的缓解状态一致，一致性系数为 0.89。灵敏度和特异性均为 91%，患者报告的缓解状态阳性预测值为 46%，阴性预测值为 99%。
在持续缓解的患者中，患者报告的缓解状态可准确排除临床显著缓解。约一半的患者报告的发作被评估为临床显著。这些发现支持在持续缓解的 RA 患者的远程监测中使用患者报告的缓解状态。
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