Combining patient-reported outcome measures to screen for active disease in rheumatoid arthritis and psoriatic arthritis

• Published in: Rheumatic & musculoskeletal diseases open Vol. 10; no. 4; p. e004687
• Main Authors: Looijen, Agnes E M, Snoeck Henkemans, Selinde V J, van der Helm-van Mil, Annette H M, Welsing, Paco M J, Koc, Gonul Hazal, Luime, Jolanda J, Kok, Marc R, Tchetverikov, Ilja, Korswagen, Lindy-Anne, Baudoin, Paul, Vis, Marijn, de Jong, Pascal H P
• Format: Journal Article
• Language: English
• Published: England EULAR 18.10.2024; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Adult; Aged; Arthritis, Psoriatic - complications; Arthritis, Psoriatic - diagnosis; Arthritis, Psoriatic - psychology; Arthritis, Rheumatoid - complications; Arthritis, Rheumatoid - diagnosis; Clinical outcomes; Fatigue - diagnosis; Fatigue - etiology; Female; Humans; Inflammatory Arthritis; Male; Mass Screening - methods; Middle Aged; Original Research; Pain; Patient Reported Outcome Measures; Patients; Presenteeism; Psoriatic arthritis; Quality of Life; Questionnaires; Remission (Medicine); Rheumatoid arthritis; Rheumatology; Severity of Illness Index; Surveys and Questionnaires; TNF inhibitors; Netherlands; patient reported outcome measures; rheumatoid arthritis; psoriatic arthritis
• ISSN: 2056-5933; 2056-5933
• DOI: 10.1136/rmdopen-2024-004687

ObjectivesTo investigate whether a combination of general health (Visual Analogue Scale (VAS)), Health Assessment Questionnaire-Disability Index (HAQ-DI), pain (VAS/Numerical Rating Scale (NRS)), quality of life (EQ-5D), fatigue (VAS/NRS) and presenteeism (0%–100% productivity loss) could aid as a screening tool to detect active disease in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA).MethodsRA patients from the tREACH trial and TARA trial (n=683) and PsA patients from the DEPAR cohort (n=525) were included. The association of a deterioration in the aforementioned patient-reported outcome measure (PROM) scores between two consecutive visits and having active disease was assessed. Active disease was defined as a change from disease activity score (DAS) ≤2.4 to DAS >2.4 in RA or Disease Activity Index in Psoriatic Arthritis (DAPSA) ≤14 to DAPSA >14 in PsA. The area under the curve (AUC) of the sum score of deteriorated PROMs was evaluated.Results4594 RA and 1154 PsA visits were evaluated and active disease occurred in 358 (8%) RA and 177 (15%) PsA visits. In both RA and PsA, a deterioration in general health (VAS), HAQ-DI, EQ-5D and pain (VAS/NRS) was significantly associated with active disease. The combination of these PROMs showed acceptable to excellent discriminative ability (RA AUC=0.76, PsA AUC=0.85). If a cut-point of ≥1 deteriorated PROMs is used, 40% of the visits in which RA patients have remission or low disease activity are correctly specified (specificity of 40%), while 10% of visits with active disease are overlooked (sensitivity of 90%). In PsA, these percentages are 41% and 4%, respectively.ConclusionA combination of general health, HAQ-DI, EQ-5D and pain could aid as a screening tool for active disease in patients with RA and PsA. These data could help facilitate remote monitoring of RA and PsA patients in the future.Trial registration numbersISRCTN26791028, NTR2754.