Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement

The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.

An Additional Core-Set Generated by People with Rheumatoid Arthritis: RA Patient Priorities for Pharmacological Interventions (RAPP-PI)

Sanderson1,  Tessa, Morris2,  Marianne, Calnan3,  Michael, Richards4,  Pamela, Hewlett2,  Sarah

University of West England, Bristol, United Kingdom,
University of West of England, Bristol, United Kingdom,
University of Kent, Canterbury, United Kingdom,
University of Bristol, Bristol, United Kingdom


Existing core sets of outcomes in RA clinical trials and treatment decisions comprise function, patient global assessment and pain. This study aimed to determine RA patient priorities for treatment outcomes in drug interventions.


A survey comprising 32 outcomes generated and prioritized by patients using interviews and nominal groups1,2 was posted to RA patients, identified through 3 diverse databases at 3 different UK hospitals, and to people randomly selected from the National RA Society (NRAS) membership database. Patients were asked to rate the importance of each outcome (1–5) for a pharmacological intervention, and to rank their top 6 outcomes (1–6). Demographics, disease activity (DAS patient global VAS, pain Numerical Rating Scale, fatigue NRS and HAQ), self-efficacy (NRS for managing your RA, RASE scale) and well-being (NRS) were measured. Importance and priority scores were calculated, and chi squared tests computed.


254 surveys were returned, with a mean age of 62.41 yrs (SD 12.39), disease duration of 12.76 yrs (SD 10.64). 51.6% of patients were taking DMARDS, and 39.4% biologic therapies. Using the rankings of top 6 items, the RAPP-PI core set comprises 8 outcomes most highly prioritised by patients: pain, activities of daily living, visible joint damage, mobility, life enjoyment, independence, fatigue, and valued activities. In addition, 3 global outcomes were identified as important to measure from the patient perspective: quality of life, well-being and normality.

Priorities differed across patient and disease characteristics. For example, severe disability was significantly associated with the prioritisation of 'More mobility' (X2= 24.80) and 'Able to do everyday things' (X2=11.74), whereas mild disability was associated with the selection of 'Enjoy life' (X2= 7.67), 'Able to work' (X2= 17.28), and 'Valued activities' (X2= 6.98, all p<0.05).


The RAPP-PI, a core-set of outcomes generated and prioritized by people with RA, indicates that current drug trials and clinical practice using existing core sets may be leading to treatment decisions based on data that excludes outcomes patients consider important. It is suggested consideration be given to using the additional outcomes of the RAPP-PI. An ongoing study will identify appropriate instruments to measure the RAPP-PI and determine the relative contribution of each outcome to global patient well-being.

1Sanderson, T, , Rheumatology 2008; 47 (2): 541

2Sanderson, T, , Arth Rheum 2008; 58; 9S: 1903

To cite this abstract, please use the following information:
Sanderson, Tessa, Morris, Marianne, Calnan, Michael, Richards, Pamela, Hewlett, Sarah; An Additional Core-Set Generated by People with Rheumatoid Arthritis: RA Patient Priorities for Pharmacological Interventions (RAPP-PI) [abstract]. Arthritis Rheum 2009;60 Suppl 10 :1205
DOI: 10.1002/art.26279

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