Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.

A Pilot Study To Quantify Suffering among Patients with Rheumatoid ArthritisA New Measure for Patient Reported Outcome (PRO).

Sensky2,  Tom, Alten4,  Rieke, Bertin1,  Philippe, Haraoui3,  Boulos, Keystone5,  Ed C., Taylor2,  Peter C.

CHU Dupuytren, Limoges, France
Imperial College, London, London, United Kingdom
Institut de Rhumatologie de Montreal, Montreal, QC, Canada
Schlosspark-Klinik UnivMed, Berlin, Germany
University of Toronto, Toronto, ON, Canada


The potential gravity of adverse outcomes in rheumatoid arthritis (RA) is such that there is a need for outcome measures which not only reflect this but are also meaningful to patients, the public and clinicians. Alleviation of suffering is a key goal in medicine. The Pictorial Representation of Illness and Self Measure (PRISM) is a novel, validated, brief method of measuring suffering consistent with Cassell's seminal conceptualisation of suffering. Pilot data are reported on using PRISM to assessing suffering in RA.


The survey was conducted on a convenience sample of 245 patients with clinically diagnosed RA from specialist clinics in Berlin, Limoges, London and Montreal during their routine clinic appointments with rheumatologists.

Basic sociodemographic and clinical data were collected, and all patients were asked to complete the PRISM task. Information was collected about patients' perceptions of the causes of their suffering.


PRISM took 1–4 minutes to complete, and was easy to use. Most patients understood the simple instructions. Patients were consistent in their appraisal of their suffering which was related to the perceived controllability of the symptoms of RA, and/or the intrusiveness of the illness on valued aspects of the individual's life. Suffering quantified by PRISM showed significant correlations with global disease VAS (rs=0.36, p<0.0001) and pain VAS (rs=0.31, p<0.0001). In logistic regression analysis, with suffering dichotomised into 'high' and 'low', global disease VAS was a significant predictor (Exp(beta)=0.97, 95% CI 0.94 to 0.99, p<0.05), but pain VAS did not contribute significantly.


This pilot survey has confirmed that PRISM is easy to use in different languages without need for specific training, is very acceptable to patients and clinicians, and can be readily incorporated into routine clinical practice. It measures something distinct from pain and global disease burden, but associated with these. These data support further investigation of PRISM as a novel patient-reported outcome which quantifies factors salient to each individual with respect to the impact of the illness and its treatment and is likely to incorporate a wider range of such influences than existing measures. As such, it may have utility in setting agreed therapeutic targets.


This pilot study was carried out with the support of an unrestricted grant from UCB.

To cite this abstract, please use the following information:
Sensky, Tom, Alten, Rieke, Bertin, Philippe, Haraoui, Boulos, Keystone, Ed C., Taylor, Peter C.; A Pilot Study To Quantify Suffering among Patients with Rheumatoid ArthritisA New Measure for Patient Reported Outcome (PRO). [abstract]. Arthritis Rheum 2010;62 Suppl 10 :987
DOI: 10.1002/art.28754

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