Rheumatoid Arthritis Impact Of Disease Research Articles

SAT0473 Defining cut-off values for disease activity states and improvement scores for patient-reported outcomes: the example of the rheumatoid arthritis impact of disease (RAID)

BackgroundThe Rheumatoid Arthritis Impact of Disease (RAID) is a patient-reported outcome measure evaluating the impact of rheumatoid arthritis (RA) on patient quality of life. It comprises 7 domains that are...

SAT0450 Are females with rheumatoid arthritis caught in a vicious circle of pain, fatigue and sleep disturbance?

BackgroundSleep quality is an important aspect of health and well-being and the Outcome Measures in Rheumatology Clinical Trials group has identified sleep quality as a key concern for rheumatoid arthritis...

OP0197 Many patients with rheumatoid arthritis remain physically inactive

BackgroundPhysical inactivity is a major recognized public health challenge. Rheumatoid arthritis (RA) limits physical function, and physical inactivity may contribute to the increased risk of cardiovascular disease in patients with...

FRI0081 Three of a kind (and even rarer than the poker hand): a comparison of single-item pain scales frequently used in rheumatoid arthritis patients

BackgroundPain is the most limiting symptom of rheumatoid arthritis (RA) from the patients’ perspective [1]. Surprisingly, a psychometric comparison of common single-item scales measuring pain in RA (i.e. the visual...

Patient's global assessment of disease activity: What are we measuring?

There is a growing interest in the use of patientreported outcomes in rheumatoid arthritis (RA) clinical trials as well as in clinical practice (1). More and more, patients actively participate in shared decision-making, and these processes require outcome measures that are relevant and understandable by patients (2). It has also been shown that many patient-reported outcomes can distinguish active treatments from control treatments as effectively as “objective” measures can (3–5). Most patient-reported outcomes data are much more easily collected than are joint counts or laboratory data (6). The American College of Rheumatology (ACR) core set of disease activity measures in RA clinical trials contains 3 patient-reported outcomes: patient’s global assessment of disease activity, pain, and physical function (7,8). However, the Outcome Measures in Rheumatology (OMERACT) initiative, which included “expert patient” representatives as workshop participants, recommended in 2006 that all trials should additionally include a measure of fatigue (9,10). This recommendation was endorsed by the European League Against Rheumatism (EULAR) and the ACR in their collaborative recommendations published in 2008 (11). One of the available instruments for measuring fatigue is the recently validated Bristol RA Fatigue (BRAF) questionnaire, which was designed to measure fatigue in all its dimensions (12). Other new and promising patient-reported outcomes include the Rheumatoid Arthritis Impact of Disease (RAID) questionnaire, which measures the patient’s perceived impact of RA on daily health (13), and the Routine Assessment of Patient Index Data 3 (RAPID-3), an index of 3 patient measures from the core set of disease activity measures in RA clinical trials (physical function, pain, and patient’s global assessment) that was designed for use in a busy clinical setting (14). Despite the growing interest in the development and use of patient-reported outcomes in the field of rheumatology, their interpretation is not always easy.

Patient-reported outcomes in rheumatoid arthritis

In recent years, there has been increasing interest, as indicated by a growing number of citations in the medical literature, on the assessment of outcomes in patients with rheumatoid arthritis (RA) focusing on the patient's perspective. This article describes the domains of patient-reported outcomes (PROs), instruments for measuring responses, as well as the use of PRO in clinical trials with newer agents, including biologic agents. At the 10th Outcome Measure in Rheumatology Clinical Trials (OMERACT) conference, several methodological issues about the choice of PRO domains, the development of instruments measuring these domains, and the methods for assessing response criteria were addressed. Composite domains like the RA impact of disease (RAID) score and core outcomes for the RA patient priorities for pharmacologic interventions (RAPP-PI) were introduced. Minimally clinically important differences in various PROs have been used to measure responsiveness to change in clinical trials. Many randomized clinical trials show significant improvements in PRO, such as the health assessment questionnaire disability index, and the medical outcomes study short form with effective treatment. PRO has become an essential part when assessing patients with RA. This trend will likely continue into the future, in both clinical trials as well as clinical practice.

Defining cut-off values for disease activity states and improvement scores for patient-reported outcomes: the example of the Rheumatoid Arthritis Impact of Disease (RAID)

IntroductionThe Rheumatoid Arthritis Impact of Disease (RAID) is a patient-reported outcome measure evaluating the impact of rheumatoid arthritis (RA) on patient quality of life. It comprises 7 domains that are evaluated as continuous variables from 0 (best) to 10 (worst). The objective was to define and identify cut-off values for disease activity states as well as improvement scores in order to present results at the individual level (for example, patient in acceptable state, improved patient).MethodsPatients with definite active RA requiring anti-tumour necrosis factor (anti-TNF) therapy were seen at screening, baseline and after 4 and 12 weeks of etanercept therapy. Answers to "Gold standard" questions on improvement (MCII: Minimum Clinically Important Improvement) and an acceptable status (PASS: Patient Acceptable Symptom State) were collected as well as the RAID score and Disease Activity Score 28- erythrocyte sedimentation rate (DAS28-ESR). Cut-offs were defined by different techniques including empirical, measurement error and gold standard anchors. The external validity of these cut-offs was evaluated using the positive likelihood ratio (LR) based on the patient's perspective (for example, patient's global) and on low disease activity status (such as DAS28-ESR).ResultsNinety-seven (97) of the 108 recruited patients (age: 54 ± 13 years old, female gender: 75%, rheumatoid factor positive: 81%, disease duration: 8 ± 7 years, CRP: 18 ± 30 mg/l, DAS28-ESR: 5.4 ± 0.8) completed the 12 weeks of the study. The different techniques suggested thresholds ranging from 0.2 to 3 (absolute change) and from 6 to 50% (relative change) for defining MCII and thresholds from less than 1 to less than 4.2 for defining PASS. The evaluation of external validity (LR+) showed the highest LR+ was obtained with thresholds of 3 for absolute change; 50% for relative change and less than 2 for an acceptable status.ConclusionsThis study showed that thresholds defined for continuous variables are closely related to the methodological technique, justifying a systematic evaluation of their validity. Our results suggested that a change of at least 3 points (absolute) or 50% (relative) in the RAID score should be used to define a MCII and that a maximal value of 2 defines an acceptable status.Trial RegistrationClinicaltrial.gov: NCT004768053

Clinical utility of the RAID (RA impact of disease) score

A new patient self-assessment tool shows promise as a simple measure of the overall impact of rheumatoid arthritis on a patient, but will it be able to gain the international acceptance required to become a clinical standard?

Finalisation and validation of the rheumatoid arthritis impact of disease score, a patient-derived composite measure of impact of rheumatoid arthritis: a EULAR initiative

ObjectiveA patient-derived composite measure of the impact of rheumatoid arthritis (RA), the rheumatoid arthritis impact of disease (RAID) score, takes into account pain, functional capacity, fatigue, physical and emotional wellbeing,...

Performance of the Rheumatoid Arthritis Impact of Disease (RAID) score in relation to other patient-reported outcomes in a register of patients with rheumatoid arthritis

ObjectiveDelegates at the Outcome Measures in Rheumatology (OMERACT) 10 conference (Borneo, 4–8 May 2010) questioned how the new seven-domain Rheumatoid Arthritis Impact of Disease (RAID) score performs as a global...

Elaboration of the preliminary Rheumatoid Arthritis Impact of Disease (RAID) score: a EULAR initiative

Background:Current response criteria in rheumatoid arthritis (RA) usually assess only three patient-reported outcomes (PROs): pain, functional disability and patient global assessment. Other important PROs such as fatigue are not included.Objective:To...