Abstract
IntroductionThe patient global assessment of disease activity is a crucial component of various measures of disease activity in rheumatoid arthritis (RA). Our objective was to identify underlying latent traits driving the patient global assessment using a quantitative, multivariable data reduction approach.MethodsThis was a prospective cross-sectional study of consecutive patients with RA. The patient sample was stratified to include 50 patients with patient-provider discordance (i.e., at least 25-mm absolute difference between the patient and provider global assessments) and 20 patients with patient-provider concordance (i.e., less than 25-mm absolute difference between the patient and provider global assessments). Data were collected from the most recent rheumatology visit, including patient characteristics, current RA medications, and comorbidities. Participants completed several validated patient-reported outcome measures. The data were evaluated using factor analysis, and then linear regression was used to determine the variability in the patient global assessment explained by the factor scores.ResultsThe study included 70 patients with mean age of 61 years, 73% female, and with mean disease duration of 8 years. The means (SD) for the patient and provider global assessments were 44.6 (22.7) and 20.1 (17.7), respectively. Factor analysis yielded eight factors that represented measurements of pain, fatigue, depression or anxiety symptoms, prior diagnosis of depression or anxiety, advanced age and degenerative arthritis, inability to participate, fibromyalgia (clinical diagnosis and Widespread Pain Index), and undetermined. Linear regression analysis showed that fibromyalgia explained the greatest proportion of the variance in the patient global assessment followed by the other factors.ConclusionLatent factors underlying the patient global assessment include pain, depression and anxiety, inability to participate, fibromyalgia, advanced age, and degenerative arthritis.
Highlights
The patient global assessment of disease activity is a crucial component of various measures of disease activity in rheumatoid arthritis (RA)
Rheumatol Ther (2017) 4:201–208 of validated disease activity scores, response criteria, and the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) definition of remission in rheumatoid arthritis (RA). Patients rate their global assessment on a visual analog scale (VAS) by answering the question, ‘‘Considering all of the ways your disease affects you, how well are you doing in the past week?’’ the patient global assesses disease from the patient perspective and encompasses various factors affecting patients in addition to RA
Recent work has revealed that 30% of patients with RA suffer from persistent undifferentiated symptoms of pain, fatigue, and functional disability despite seeming attainment of low inflammatory disease activity [9]
Summary
The patient global assessment of disease activity is a crucial component of various measures of disease activity in rheumatoid arthritis (RA). Rheumatol Ther (2017) 4:201–208 of validated disease activity scores, response criteria, and the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) definition of remission in rheumatoid arthritis (RA) Patients rate their global assessment on a visual analog scale (VAS) by answering the question, ‘‘Considering all of the ways your disease affects you, how well are you doing in the past week?’’ the patient global assesses disease from the patient perspective and encompasses various factors affecting patients in addition to RA. Recent work has revealed that 30% of patients with RA suffer from persistent undifferentiated symptoms of pain, fatigue, and functional disability despite seeming attainment of low inflammatory disease activity [9] This discordance in assessments of disease activity between patients and their providers is a critical issue, so addressing factors that influence patients’ assessments of disease activity is necessary to narrow this gap and improve patient outcomes. The purpose of this study was to identify the underlying latent factors driving the patient global assessment using a quantitative, multivariable data reduction approach
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