Page 173 - THE EVOLUTION OF EARLY ARTHRITIS AND CARDIOVASCULAR RISK Samina A. Turk

cular risk) was associated with a higher disease activity. Therefore, we recommend to calculate CV risk during a time of low disease activity.
PART III: PATIENT-REPORTED OUTCOMES AND REMISSION IN EARLY RHEUMA- TOID ARTHRITIS
The goal in RA patients is to achieve a state of low disease activity or even remission. However, many different definitions for remission exist. Therefore, in chapter 7 the fre- quencies of patients that achieved response or remission after 3 months of anti-rheu- matic treatment, according to different definitions, were examined. We found that the agreement between the assessed outcome measures varied widely. Of the 84 RA patients, 64% of the patients agreed with the physician about being in remission. To determine why some patients did not agree with the physician, the clinical outcomes and patient-reported outcomes were also assessed in patients who did and in patients who did not agree with their physician on being in remission. The results showed that patients not in self-perceived remission improved less on components of the Rheu- matoid Arthritis Impact of Disease (RAID) questionnaire, especially on pain, sleep and emotional well-being. Together with the variability in clinical response and remission definitions, these results highlight the need to increase patient involvement in their own healthcare decisions.
Previous literature identified three themes of patient-perceived remission, of which ‘re- turn to normality’ was a major theme. Although a consensus definition of ‘normality’ is not documented in the literature, a ‘normality scale’ has been developed. In chapter 8 the patient-perceived concepts of normality and remission, and the ability of the nor- mality scale to discriminate between remission and non-remission was investigated. Therefore, 47 RA patients were followed for 6 months after initiation of treat-to-target anti-rheumatic treatment and ACR/EULAR Boolean remission criteria plus the normal- ity scale were assessed before, after 13 weeks and after 26 weeks of treatment. The perception of normality increased with 20% after treatment. Patients in self-perceived remission had a higher feeling of normality at week 13 and week 26, while patients in ACR/EULAR Boolean remission only had a higher feeling of normality at week 26. This study showed that the normality scale is able to discriminate between patients in and not in remission.
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