Wording of the patient global assessment may affect rating of disease activity in patients with RA

After modification of the patient global assessment using a more detailed explanation of disease activity, investigators of a recently presented study found higher ratings of disease activity and lower rates of remission among patients with rheumatoid arthritis.

Researchers from Brigham and Women’s Hospital in Boston, the Medical University of Vienna in Austria and the Diakonhjemmet Hospital in Oslo, Norway studied data from four international centers and randomly selected 105 patients with rheumatoid arthritis (RA) from a study of six alternatively phrased patient global assessment (PtGA) questionnaires. Patients had a mean age of 57.7 years. Women made up 84.8% of the study group and 91.4% of all patients were white. Overall, 81% of patients were seropositive with a mean disease duration of 17.9 years.

Investigators used paired t-tests to compare mean values of agreement between different PtGA responses with the traditional phrasing, “Considering all of the ways your arthritis has affected you, how do you feel your arthritis is today?” and a modified, more detailed added phrase, “Active arthritis can cause joint swelling OR stiffness, pain OR discomfort in your joints. WITH ACTIVE ARTHRITIS, You CAN BE tired during the day, even when you’ve slept well.” Each set was divided into three questions with reference periods of today, last week or last month. An additional question on global health (PtGA-GH) was included in the questionnaire.

The percent of patients who fulfilled remission criteria was lowest using the PtGA-GH (9.6% Boolean remission; 21.6% clinical disease activity index remission), and lower remission rates and higher mean values were observed in responses to the detailed PtGA compared with the traditionally phrased PtGA independent from the referenced time period.

“Against our expectations, a more detailed explanation of ‘disease activity’ led to higher ratings on the PtGA scale, and lower remission rates,” the researchers wrote. “It appears to increase awareness of and attention to specific symptoms related to RA disease activity, which would otherwise be discounted.” - by Shirley Pulawski

Reference:

Radner H, et al. Paper #2646. Presented at: American College of Rheumatology Annual Meeting; Nov. 7-11, 2015; San Francisco.

Disclosure: Radner reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.