Page 137 - THE EVOLUTION OF EARLY ARTHRITIS AND CARDIOVASCULAR RISK Samina A. Turk
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PAIN, SLEEP AND EMOTIONAL WELL-BEING
BACKGROUND
Since rheumatoid arthritis (RA) patients are at risk for joint damage due to inflammation(1), the treatment goal in these patients is to attain a state of absence of disease activity, or remission(2). However, clinical response and remission are defined in multiple ways and measured with different instruments, resulting in substantial variation of the proportion of patients classified as being in remission(3;4). A particularly common difference is seen between the physician and the patients view on the RA disease activity(5-9).
The response to treatment as determined by the physician, is often based on the disease activity score (DAS), which is mainly based on physical examination and laboratory values(10;11). The DAS also contains a patient-reported outcome (PRO), i.e. the patient global assessment, however this global view lacks information on the patient’s perspective on remission(12). Furthermore, PROs such as fatigue and physical well- being, which have a large impact on daily life, are not taken directly into account(7). Nowadays, the importance of the patient’s perspective is increasingly recognized. Even though the patient’s perspective on remission is increasingly being studied and understood(12;13), it is unknown which determinants of disease activity explain the lack of agreement between physician- and patient-perceived remission. Patient satisfaction, the relationship between patient and physician, and treatment compliance can all be improved when patient and physician agree on the state of the disease(14-17), which can be reached by taking the opinion of the patient into account and thus with applying shared decision-making(18-20).
The objective of this study was twofold. First, the frequencies were examined of patients 7 that achieved physician-perceived remission, patient-perceived remission, DAS44 remission, European League Against Rheumatism (EULAR) good response, American
College of Rheumatology (ACR) 70 response, and ACR/EULAR Boolean-based definition
of remission(21-23). With this data, the agreement between patient- and physician- perceived remission with and between the different clinical definitions of response and remission was determined. Second, the differences in clinical outcomes and PROs, in patients who did and did not agree with their physician on being in remission were assessed. Our hypothesis was that we would find significant differences in patients achieving remission according to the different response and remission criteria, compared to those who do not. Secondly, we hypothesised that there would be a lack of agreement between patient and physician perceived remission and several PROs.
METHODS
Study population
The study population is part of a cohort of consecutive patients with early arthritis from the ‘Early Arthritis Cohort’ at Reade in Amsterdam, The Netherlands. This ongoing
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