Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2017

Open Access 01-12-2017 | Research article

Patient’s perspective of sustained remission in rheumatoid arthritis

Authors: Irazú Contreras-Yáñez, Guillermo Guaracha-Basañez, Daniel Ruiz-Domínguez, Virginia Pascual-Ramos

Published in: BMC Musculoskeletal Disorders | Issue 1/2017

Login to get access

Abstract

Background

During the course of rheumatoid arthritis (RA), patients have profound negative effects on their patient-reported-outcomes (PRO); in addition, the impact of sustained remission (SR) on PROs may differ for each particular outcome. The objectives of this study were to identify SR from an inception cohort of RA patients and to examine the impact of SR in an ample spectrum of PROs.

Methods

The study was developed in a well characterized and ongoing cohort of RA patients with recent onset disease recruited from 2004 onwards. In November 2016, the cohort included 187 patients, of whom 145 had at least 30 months of follow-up, with complete rheumatic assessments at regular intervals in addition to a pain visual analogue scale (PVAS), overall disease-VAS (OVAS), health assessment questionnaire (HAQ), Short-Form 36v2 Survey (SF-36) and fatigue assessment. First SR was defined according to the DAS28 cut-offs (DAS28-SR) and ACR/EULAR 2011 Boolean definition (B-SR), if maintained for at least 12 consecutive months. The dependent t test and Mc Nemar’s tests were used for comparisons between related groups. Local IRB approval was obtained.

Results

More patients achieved DAS28-SR than B-SR: 78 vs. 63, respectively. Fifty patients met both SR definitions. Follow-up to DAS28-SR was shorter than to B-SR and the duration of DAS28-SR was longer, p ≤ 0.023 for all comparisons.
At SR, patients had PRO proxy to normal values; the percentage of patients with normal PRO varied from 97% (95% CI: 91–99) for HAQ to 50% (95% CI: 39–61) for absence of fatigue.
In DAS28-SR patients, acute reactant phases within the normal range were detected very early (after 1.5–2.9 months). HAQ, PVAS, OVAS and SF-36 were scored within the normal range after 6–7 months. The absence of fatigue was detected at 8.7 months of follow-up, which was similar to DAS28-SR. In the 63 patients with B-SR, a similar pattern was observed. The follow-up to outcomes of the 50 patients who met both SR definitions was similar, but the absence of fatigue and physical component SF-36 normalization were achieved earlier in B-SR patients (p ≤ 0.02).

Conclusions

The impact of SR on PRO differs accordingly to each particular outcome.
Literature
1.
Aletaha D, Funovits J, Breedveld FC, Sharp J, Segurado O, Smolen J. Rheumatoid arthritis joint progression in sustained remission is determined by disease activity levels preceding the period of radiographic assessment. Arthritis Rheum. 2009;60:1242–9.CrossRefPubMed
2.
van der Heijde D. Remission by imaging in rheumatoid arthritis: should this be the ultimate goal? Ann Rheum Dis 2012;71(Supll):i89-i92. Doi:10.1136/annrheumdis-2011-200797.
3.
Makinen H, Kautiainen H, Hannonen P, Sokka T. Is DAS28 an appropriated tool to assess remission in rheumatoid arthritis? Ann Rheum Dis. 2005;64:1410–3.CrossRefPubMedPubMedCentral
4.
Felson DT, Smolen JS, Wells G, Zhang B, van Tuyl LH, Funovits J, et al. American College of Rheumatology/European league against rheumatism provisional definition of remission in rheumatoid arthritis for clinical trials. Ann Rheum Dis. 2011;70:404–13.CrossRefPubMed
5.
Pinals RS, Masi AT, Larsen RA. Preliminary criteria for clinical remission in rheumatoid arthritis. Arthritis Rheum. 1981;24:1308–15.CrossRefPubMed
6.
Felson D. Defining remission in rheumatoid arthritis. Ann Rheum Dis 2012;71(0 2): i86-i88. Doi:10.1136/annrheumdis-2011-200618.
7.
West E, Jonsson SW. Health-related quality of life in rheumatoid arthritis in northern Sweden; a comparison between patients with early RA, patients with medium-term disease and controls, using SF-36. Clin Rheumatol. 2005;24:117–22.
8.
Linde l, Sorensen J, Ostergaad M, Horslev-Petersen K, Hetland ML. Does clinical remission lead to normalization of EQ-5D in patients with rheumatoid arthritis and is selection of criteria important? J Rheumatol 2010;37:285-290.
9.
Kahn KL, Mclean CH, Wong AL, Rubenstein LZ, Liu H, Fitzpatrick DM, et al. Assessment of American College of Rheumatology Quality Criteria for rheumatoid arthritis in a pre-quality criteria patient cohort. Arthritis Rheum. 2007;57:707–15.CrossRefPubMed
10.
Hewlett S, Carr M, Ryan S, Kirwan J, Richards P, Carr A, et al. Outcomes generated by patients with rheumatoid arthritis: how important are they? Musculoskeletal Care. 2005;3:131–42.CrossRefPubMed
11.
Sanderson T, Kirwan J. Patient-reported outcomes of arthritis: time to focus on personal life impact measures? Editorial Arthritis Rheum. 2009;61:1–3.PubMed
12.
Hewlett S. Patients and clinicians have different perspectives on outcomes in arthritis. J Rheumatol. 2003;30:877–9.PubMed
13.
Charlson M, Szatrowsky TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol. 1994;47(11):1245–51.CrossRefPubMed
14.
Ramey DR, Raynauld JP, Fries JF. The health assessment questionnaire 1992: status and review. Arthritis Care Res. 1992;5:119–29.CrossRefPubMed
15.
16.
Maruish ME (Ed). User’s manual for the SF-36v2 health survey (3rd edition) 2011. Lincoln RI: Qualitimetric Incorporated.
17.
Contreras-Yánez I, Pascual-Ramos V. Window of opportunity to achieve major outcomes in early rheumatoid arthritis patients: how persistence with therapy matters. Arthritis Res Ther 2015;17:177. DOI 10.1186/s13075-015-0697-z.
18.
Contreras-Yánez I, Rull-Gabayet M, Pascual-Ramos V. Early disease activity suppression and younger age predict excellent outcome on recent-onset rheumatoid arthritis patients with conventional disease modifying anti-rheumatic drugs. Clin Exp Rheumatol. 2012;30:402–8.PubMed
19.
Prevoo ML, van’t Hof MA, Kuper HH, van Leeuwen MA, van de Putte LB, van Riel PL: Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum 1995;38:44-48.
20.
Krishnan E, Sokka T, Häkkinen A, Hubert H, Hannonen P. Normative values for the health assessment questionnaire disability index: benchmarking disability in the general population. Arthritis Rheum. 2004 Mar;50(3):953–60.CrossRefPubMed
21.
Durán-Arenas L, Gallegos-Carrillo K, Salinas-Escudero G, Martínez-Salgado H. Hacia una base normativa mexicana en la medición de calidad de vida relacionada con la salud, mediante el Formato Corto 36. Salud Publica Mex. 2004;46:306–15.CrossRefPubMed
22.
Fransen J, van Riel PLCM. DAS remission cut points. Clin Exp Rheumatol. 2006;24:S29–32.
23.
Bird P, Nicholls D, Barrett R, Jager JD, Griffiths H, Roberts L, et al. Longitudinal study of clinical prognostic factors in patients with early rheumatoid arthritis: the PREDICT study. Int J Rheum Dis. 2017;20(4):460–8.CrossRefPubMed
24.
Radner H, Smolen JS, Aletaha D. Remission in rheumatoid arthritis: benefit over low disease activity in patient-reported outcomes and costs. Arthritis Res Ther. 2014;16:R56.CrossRefPubMedPubMedCentral
25.
Js S, Aletaha D, Bijlsma JW, Breedveld FC, Boumpas D, Burmester G, et al. Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis. 2010;69:631–7.CrossRef
26.
Thiele K, Huscher D, Bischoff SL, Späthling-Mestekemper S, Backhaus M, Aringer M, et al. Performance of the 2011 ACR/EULAR preliminary remission criteria compared with DAS28 remission in unselected patients with rheumatoid arthritis. Ann Rheum Dis. 2013;72:1194–9.CrossRefPubMed
27.
Kirkham JJ, Boers M, Tugwell P, Clarke M, Williamson PR. Outcome measures in rheumatoid arthritis randomized trials over the last 50 years. Trials. 2013;14:324.CrossRefPubMedPubMedCentral
28.
Gossec L, Dougados M, Dixon W. Patient-reported outcomes as end points in clinical trials in rheumatoid arthritis. RMD Open 2015;1:e000019.doi:10.1136/rmdopen-2014-000019.
29.
Bykerk V, Massarotti EM. The new ACR/EULAR remission criteria: a rationale for developing new criteria for remission. Rheumatology 2015;51:vi16-vi20. Doi:10.1093/rheumatology/kes281.
30.
Kuriya B, Sun Y, Boire G, Haraoui B, Hitchon C, Pope JE, et al. Canadian early arthritis cohort. Remission in early rheumatoid arthritis- a comparison of new ACR/EULAR remission criteria to established criteria. J Rheumatol. 2012;39:1155–8.CrossRefPubMed
31.
Sakellariou G, Scire CA, Verstappen SM, Montecucco C, Carporali R. In patients with early RA the new ACR/EULAR definition of remission identifies patients with persistent absence of functional disability and suppression of ultrasonographic synovitis. Ann Rheum Dis. 2013;72:245–9.CrossRefPubMed
32.
Aletaha D, Ward MM, Machold KP, Nell VPK, Stamm T, Smolen JS. Remission and active disease in rheumatoid arthritis: defining criteria for disease activity states. Arthritis Rheum. 2005;52:2625–36.CrossRefPubMed
33.
Aletaha D, Smolen J, Ward MM. Measuring function in rheumatoid arthritis: identifying reversible and irreversible components. Arthritis Rheum. 2005;54:2784–92.CrossRef
34.
Hillsdon MM, Brunne EJ, Guralnik JM, Marmot MG. Prospective study of physical activity and physical function and early old age. Am J Prev Med. 2005;28:245–50.CrossRefPubMed
35.
Jakobsson U, Hallberg IT. Pain and quality of life among older people with rheumatoid arthritis and/or osteoarthritis: a literature review. J Clin Nurs. 2002;11:430–43.CrossRefPubMed
36.
Radner H, Alasti F, Smolen JS, Aletaha D. Physical function continues to improve when clinical remission is sustained in rheumatoid arthritis patients. Arthritis Res Ther. 2015;17:203.CrossRefPubMedPubMedCentral
37.
Hewlett S, Chalder T, Choy E, Cramp F, Davis B, Dures E, et al. Fatigue in rheumatoid arthritis: time for a conceptual model. Rheumatology (Oxford). 2011;50:1004–6.CrossRef
38.
Curtis JR, Shan Y, Harrold L, Zhang J, Greenberg JD, Reed GW. Patient perspectives on achieving treat to target goals: a critical examination of patient-reported outcomes. Arthritis Care Res (Hoboken). 2013;65:1707–12.CrossRef
39.
Van Hoogmoed D, Fransen J, Repping-Wuts H, Spee L, Bleijenberg G, van Riel PL. The effects of anti-TNF versus DMARDs on fatigue in rheumatoid arthritis patients. Scan J Rheumatol. 2013;42:15–9.CrossRef
40.
Olsen CL, Lie E, Kvien TK, Zangi HA. Predictors of fatigue in rheumatoid arthritis patients in remission or in low disease activity. Arthritis Car Res. 2016;68:1043–8.CrossRef
41.
Nikolaus S, Bode C, Taal E, van de Laar MA. Fatigue and factors related to fatigue in rheumatoid arthritis: a systematic review. Arthritis Car Res (Hoboken). 2013;65:1128–46.CrossRef
42.
Altawil R, Saevarsdottir S, Wedren S, Alfredsson L, Klareskog L, Lampa J. Remaining pain in early rheumatoid arthritis patients treated with methotrexate. Arthritis Car Res. 2016;68:1061–8.CrossRef
43.
Lane SK, Gravel JW Jr. Clinical utility of common serum rheumatologic tests. Am Fam Physician. 2002 Mar 15;65:1073–80.PubMed
44.
Hewlett S, Dures E, Almeida C. Measures of Fatigue. Bristol Rheumatoid Arthritis Fatigue Multi-Dimensional Questionnaire (BRAF MDQ), Bristol Rheumatoid Arthritis Fatigue Numerical Rating Scales (BRAF NRS) for Severity, Effect, and Coping, Chalder Fatigue Questionnaire (CFQ), Checklist Individual Strength, (CIS20R and CIS8R), Fatigue Severity Scale (FSS), Functional Assessment Chronic Illness, Therapy (Fatigue) (FACIT-F), Multi-Dimensional Assessment of Fatigue (MAF), Multi-Dimensional Fatigue Inventory (MFI), Pediatric Quality Of Life (PedsQL) Multi-Dimensional Fatigue Scale, Profile of Fatigue (ProF), Short Form 36 Vitality Subscale (SF-36 VT), and Visual Analog Scales (VAS). Arthritis Car Res 2011;63:S263.86.
45.
Covic T, Cumming SR, Pallant JF, Manolios N, Emery P, Conaghan PG, et al. Depression and anxiety in patients with rheumatoid arthritis: prevalence rates based on a comparison of the depression, anxiety and stress scale (DASS) and the hospital anxiety and depression scale (HADS). BMC Psychiatry. 2012;12:6.CrossRefPubMedPubMedCentral
46.
Berkanovic E, Hurwicz ML, Lachewnbruck CA. Concordant and discrepant views of patient’s physical functioning. Arthritis Car Res. 1995;8:94–101.CrossRef
47.
Molzhan AE, Northcott HC. The social bases of discrepancies in health/illness perceptions. J Adv Nurs. 1989;14:132–40.CrossRef
Metadata
Title
Patient’s perspective of sustained remission in rheumatoid arthritis
Authors
Irazú Contreras-Yáñez
Guillermo Guaracha-Basañez
Daniel Ruiz-Domínguez
Virginia Pascual-Ramos
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2017
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-017-1717-8

Other articles of this Issue 1/2017

BMC Musculoskeletal Disorders 1/2017 Go to the issue

Research article

Fibroma of tendon sheath around large joints: clinical characteristics and literature review

Technical advance

Modified minimally invasive extensor carpi radialis longus tenodesis for scapholunate dissociation: a prospective observational study

Case report

Cementoma of the calcaneus: a case report

Research article

Increased fragility fracture risk in Korean women who snore: a 10-year population-based prospective cohort study

Case report

A rare case of osteoblastoma combined with severe scoliosis deformity, coronal and sagittal imbalance

Technical advance

Modifications to advanced Core decompression for treatment of Avascular necrosis of the femoral head