Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.


The Relationship Between the Polymyalgia Rheumatica Activity Score and Patient Reported Outcomes in Polymyalgia Rheumatica.

McCarthy,  EM, MacMullan,  Paul A., Al-Mudhaffer,  S., Madigan,  A., Donnelly,  S., McCarthy,  Cj, McCarthy,  G. M.

Background/Purpose:

Patient reported outcomes(PROs) are increasingly being used for the assessment and monitoring of patients with rheumatic diseases. Standard PROs include the Health Assessment Questionnaire (HAQ),Visual Analogue Scale(VAS) for patient assessment of disease activity(VASDA) and VAS quality of life(VASQoL). PROs suitable for use in clinical care should be feasible with minimum respondent and administrative burden. In PMR, disease activity is measured using the PMR-AS as indicated by Leeb and Bird – PMR-AS = CRP(mg/dl) + VAS pain(0–10scale) + VASphysician (0–10scale)+Morning stiffness([min]x.1)+ Upper Limb Elevation (0–3 scale). Little data is available on how the PMR-AS reflects PROs.

Objectives:

To prospectively evaluate the strength of correlation between PROs and PMR-AS in patients with known PMR and identify the best PRO measure for use in the clinical setting.

Methods:

60 patients with PMR were divided into Active disease (group 1, n=25) or Inactive disease( group 2,n=35), based on symptoms, physician assessment and ESR. Both groups underwent clinical and laboratory assessment at baseline and week 6. The following disease activity data were collected: PMR-AS, VasDA, VASQoL and HAQ. Between group disease activity data were assessed using Wilcoxon Signed Rank Test. Spearman's rank correlation coefficient(Spearman's rho) was used to directly compare the PMR-AS to the HAQ, VASDA and VASQoL. Measures of responsiveness including Standardised response means and effect size statistics were calculated for all outcome measures. Receiver operator curves (ROC) were calculated for the PROs.

Results:

Demographic data was similar in all groups. Mean values for each disease measure are shown in Table 1. Disease activity scores improved significantly in the active group between week I and week 6 reflecting response to steroid treatment. There was no significant difference between the mean disease scores at week 6 in the Active group and the Inactive group.

Table 1. Mean disease measures at Weeks I and 6 in Active and Inactive Groups

 Active PMR-Week 1Active PMR-Week 6Wilcoxon p valueInactive PMR –Week 1Inactive PMR –Week6Wilcoxon p value
PMR-AS26.186.8<.00015.164.8n/s
HAQ1.51.51<.0003.53.49n/s
VASDA7.382.78<.00012.192.14n/s
VASQoL7.583.13<.00012.082.19n/s

Analysis of PMR-AS vs VASDA, VASQoL and HAQ showed correlation coefficients of 0.87(p<.001), 0.80(p<.001) and 0.68(p<.001), respectively.

VasDA and VasQoL are more responsive to change in disease activity than HAQ and PMR-AS (Table 2).

Table 2. Measures of responsiveness

 Standardised Response MeansEffect Size
VasDA1.762.52
VasQoL1.742.27
PMR-AS1.541.84
HAQ1.361.65

ROC analysis revealed VASDA to be more specific than either HAQ(.95 vs.85, p<.001) or VASQoL (.95 vs.93, p<.001) for the detection of response to treatment in active PMR.

Conclusion:

VASDA, VASQoL and HAQ are strongly correlated with the PMR-AS. VASDA is more responsive to change in disease activity than the VASQoL, PMR-AS and HAQ. VASDA is inexpensive and easily administered in rheumatology clinics. We recommend its routine use in clinical practice.

To cite this abstract, please use the following information:
McCarthy, EM, MacMullan, Paul A., Al-Mudhaffer, S., Madigan, A., Donnelly, S., McCarthy, Cj, et al; The Relationship Between the Polymyalgia Rheumatica Activity Score and Patient Reported Outcomes in Polymyalgia Rheumatica. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :1514
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