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.


Do Rheumatoid Arthritis Patients Meeting American College of Rheumatology/European League Against Rheumatism Remission Have Improved Functional Ability, Quality of Life and Work Productivity Compared to Those with Low Disease Activity?

Patel1,  Aarat M., Amity2,  Christine L., Frydrych2,  Lynne M., Sippel2,  Derek, Jones2,  Donald, Goudeau2,  Danielle, Eng3,  Heather

Univ of Pittsburgh Med Ctr / Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA
Univ of Pittsburgh Med Ctr, Pittsburgh, PA
Univ of Pittsburgh, Pittsburgh, PA
Brigham & Womens Hospital, Boston, MA
University of Pittsburgh, Pittsburgh, PA

Background/Purpose:

RA patients meeting the new ACR/EULAR definition of remission should have better clinical outcomes than those with low disease activity. Therefore, we compared functional ability, HRQOL, work impairment and medication use between those meeting new ACR/EULAR remission and those in low disease activity or other defined states of remission.

Methods:

Subjects were from the University of Pittsburgh Rheumatoid Arthritis Comparative Effectiveness Research (RACER) registry (n=721). We analyzed self-administered patient questionnaires (routine assessment of patient index-3 (RAPID3), short form-12 (SF12), work productivity and activity impairment (WPAI)), physician exam data (DAS28 and CDAI) from a single RACER visit. Subjects were grouped according to whether they met ACR/EULAR remission, DAS28 and CDAI remission, low, moderate and high disease activity. Demographics, questionnaire data and medication use were compared between those who did not fulfill the new remission criteria but did fulfill other remission and low disease activity states using Mann Whitney-U and Pearson Chi-Square tests.

Results:

ACR/EULAR remission was achieved by 17.6% of the cohort. Age, sex, race and disease duration were similar between disease activity groups. The mean SF-12 physical and mental component scores (PCS / MCS) for subjects in ACR/EULAR remission were similar to healthy, comparably aged subjects. Subjects in CDAI remission (n=109) also met ACR/EULAR remission and had comparable SF-12, WPAI and RAPID3 scores (data not shown). In contrast, not all subjects in DAS28 remission (n=274) also met the ACR/EULAR definition of remission (n=127). Subjects in DAS28 remission but not ACR/EULAR remission (n=147) and subjects in DAS28 and CDAI low disease activity had worse SF12, WPAI and RAPID3 scores (Table 1). The use of DMARDs and/or biologics was similar between the remission and low disease activity groups. However, the ACR/EULAR and CDAI remission groups used significantly less narcotics and corticosteroids than subjects in DAS remission and all other disease activity groups (p<0.0001).

Table 1. Comparison of different remission and low disease activity definitions to the ACR/EULAR definition of remission and their effect on work productivity and health assessment (n = 721)

 ACR/EULAR Remission (n = 127)DAS28 Remission (n = 147)PDAS28 Low Disease Activity (n = 125)PCDAI Low Disease Activity (n = 246)P
SF12 PCS45.8 ± 9.438.4 ± 9.1<0.000134.4 ± 8.9<0.000136.76 ± 9.3<0.0001
  MCS52.4 ± 8.148.8 ± 10.00.00547.0 ± 9.4<0.000148.0 ± 9.9<0.0001
WPAI (%) Activity Imp.13.7 ± 20.729.4 ± 26.3<0.000142.6 ± 24.2<0.000135.1 ± 26.6<0.0001
  Time mixed0.6 ± 3.29.6 ± 23.70.012.7 ± 11.40.1435.9 ± 17.80.011
  Imp. Working9.4 ± 18.520.0 ± 21.9<0.000129.3 ± 25.2<0.000124.5 ± 22.8<0.0001
  Overall Imp.10.1 ± 18.725.8 ± 29.4<0.000131.5 ± 26.6<0.000128.0 ± 26.8<0.0001
RAPID51.0 ± 1.01.9 ± 1.7<0.00013.4 ± 1.8<0.00013.0 ± 1.8<0.0001
* Remission definitions were individually applied to all subjects and those fulfilling ACR/EULAR remission are removed from other categories so some subjects are not represented in multiple groups.** Those in CDAI remission fulfilled ACR/EULAR remission so comparisons were not made.
RACER = Rheumatoid Arthritis Comparative Effectiveness Research ACR/EULAR = American College of Rheumatology/European League Against Rheumatism; DAS28 = disease activity score 28-joint count; CDAI = clinical disease activity index; SF12 = short form-12; PCS = physical component score; MCS = mental component score; WPAI = Work Productivity and Activity Impairment; RAPID3 = Routine Assessment of Patient Index Data-3

Conclusion:

RA subjects in ACR/EULAR remission had a quality of life similar to healthy comparably aged subjects suggesting that the new ACR/EULAR remission criteria represent a true state of remission. The DAS28 definition of remission is not comparable since RA subjects in ACR/EULAR remission had better RAPID3, SF12 and WPAI scores. ACR/EULAR remission was associated with improved functional ability, HRQOL and work productivity compared to DAS28 and CDAI low disease activity. Medication data suggests that for subjects not in remission, achieving remission will require more optimal and/or greater use of combinations of immunosuppressive therapies. Our future goal is to determine the cost-effectiveness and the risk:benefit of more aggressive treatment approaches for patients not yet in remission and to study remission longitudinally.

To cite this abstract, please use the following information:
Patel, Aarat M., Amity, Christine L., Frydrych, Lynne M., Sippel, Derek, Jones, Donald, Goudeau, Danielle, et al; Do Rheumatoid Arthritis Patients Meeting American College of Rheumatology/European League Against Rheumatism Remission Have Improved Functional Ability, Quality of Life and Work Productivity Compared to Those with Low Disease Activity? [abstract]. Arthritis Rheum 2011;63 Suppl 10 :2516
DOI:

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