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Physician assessment primarily dictated increases in early rheumatoid arthritis treatment
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Physician global assessment was a stronger factor than Disease Activity Score 28 in determining increased treatment for patients with early rheumatoid arthritis, according to study results.
“We did this research because in Canada, we do not use the DAS score in routine practice. We place more weight on the swollen joint count and our informed assessment,” researcher Janet E. Pope, MD, MPH, FRCPC, professor of medicine and division head of rheumatology at St. Joseph’s Hospital and Schulich School of Medicine & Dentistry, University of Western Ontario, told Healio.com. “We thought that these factors would be the main predictors of increasing treatment and indeed this was the case.”
Janet E. Pope
Researchers studied data from 1,145 patients with early rheumatoid arthritis (ERA) in the Canadian Early Arthritis Cohort. Patients had to have at least two office visits, with data from baseline and 6 months. Factors associated with treatment intensification were determined through regression analysis.
Seven hundred-ninety patients (mean age, 53.4 years; 75% women) with mean disease duration of 6.1 months were eligible for inclusion. Mean Disease Activity Score 28 (DAS28) was 4.7 at baseline and 2.9 at 6 months. Physician global assessment (MDGA; OR=7.8, 3 months; OR=7.4, 6 months), swollen joint count (SJC; OR=4.7, 3 months; OR=7.3, 6 months) and DAS28 (OR=3.0, 3 months; OR=4.6, 6 months) were determined through univariate analysis (P<.0005 for all). Only MDGA (OR=1.5, 3 months; OR=1.2, 6 months; P<.0005) was strongly associated with intensified treatment using regression analysis, while DAS28 was not consistently predictive (OR=1.0, P=.987, 3 months; OR=1.2, P=.023, 6 months). DAS28 dictated treatment intensification 2.3% of the time, compared with SJC (51.7%), tender joint count (49.9%) and MDGA (23.8%). Larger joint involvement was more likely than small joints at 3 months to influence treatment for the same SJC (OR=1.4; P=.027).
“Trained physician ‘gestalt’ in RA is important,” Pope said. “… We can’t just put patient scores into a computer and get a score to tell us to change treatment, we have to interpret what we see.”
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