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Patient-reported outcomes seen as poor predictors of disease activity change for RA
Patient-reported outcomes, like pain, fatigue and stiffness, were minimally useful as predictors of rate changes in disease activity and disability in patients with rheumatoid arthritis, according to findings of this study.
esearchers evaluated data from the Yorkshire Early Arthritis Register (YEAR), an observational inception cohort of adult patients diagnosed with recent-onset rheumatoid arthritis (RA). Researchers identified 1,415 patients enrolled in the YEAR between 1997 and 2009. Eligible participants also were required to have inflammatory symptoms lasting at least 24 months and have initiated treatment with disease-modifying antirheumatic drugs (DMARDs). At the start of data collection in 1997, the first-line DMARD was sulfasalazine. This changed to methotrexate when the data collection and treatment protocols were revised in 2002.
Data were culled from baseline to 1 year. Researchers constructed multilevel models to evaluate baseline DAS-28 and health assessment questionnaire (HAQ-DI), as well as changes in these measures at 12 months. The model included conventionally reported predictors of RA outcome, such as sex, antibody status and age, as well as patient-reported pain, fatigue and duration of early-morning stiffness (EMS).
Researchers found that at baseline, DAS28 was higher in patients enrolled prior to 2002, as well as in older patients, those with longer disease duration and those with greater pain, fatigue, and longer duration of EMS.
ightly faster DAS28 reduction (by 0.01 units per decade of baseline age). All statistically significant effects of baseline variables on DAS28 change were minimal. At 1 year, the estimated differences between patients by sex, age (80 years vs. 50 years) and cohort (for pain VAS values ranging from 4 cm to 8 cm) were not greater than 0.6 DAS28 units. The correlation between baseline pain and stiffness with DAS28 change varied depending on whether patients were enrolled before or after 2002. A slightly stronger association between greater pain VAS at baseline and a marginal drop in DAS28 per month was seen in patients recruited after 2002 vs. those recruited after that year.
Patients recruited before 2002 showed no association between baseline EMS and DAS28 rate change, but the later cohort showed a greater decrease in DA28 with a longer duration of EMS.
In terms of HAQ-DI, women recruited after 2002 had a 0.217 units higher baseline HAQ-DI than men recruited at that time, and women recruited before 2002 a 0.091-unit higher HAQ-DI than their male counterparts. However, the rate of change in HAQ-DI by gender was consistent between the groups, with an average reduction of 0.028 units per month in men and a 0.023/month decrease in women. Decrease in HAQ-DI was between 0.006 units and was 0.004 units per month faster per unit of baseline DAS28. Patients recruited prior to 2002 showed no association between baseline pain and HAQ-DI reduction, but the later cohort display a slightly stronger trend.
“Our study showed that [patient-reported outcomes] PRO at baseline, such as pain, fatigue and stiffness, are not useful for the prediction of RA change in disease activity and disability,” the researchers wrote. - by Jennifer Byrne
Disclosure: Healio/Rheumatology was unable to determine whether the authors had relevant financial disclosures.