Page 145 - THE EVOLUTION OF EARLY ARTHRITIS AND CARDIOVASCULAR RISK Samina A. Turk

PAIN, SLEEP AND EMOTIONAL WELL-BEING
RAID: Rheumatoid Arthritis Impact of Disease questionnaire, SD: standard deviation, SJC44: swollen joint count of 44 joints, TJC44: tender joint count of 44 joints, VAS: visual analogue scale.
*significant difference (p<0.05) in baseline values for patients in and not in self-perceived remission after 12 weeks of treatment
DISCUSSION
More than one-third of early RA patients disagreed with their physician on being in remission after 12 weeks of treatment. The agreement between physician and patient was higher in patients who did achieve DAS44 remission, ACR70 response or were in Boolean-based remission. Patients who judged themselves as not being in self- perceived remission showed less improvement on the RAID questions on sleep, pain and emotional well-being, compared with patients who judged themselves as being in self-perceived remission.
In this study all patients received the same anti-rheumatic treatment, which led to an improvement in disease activity of all patients. The improvement of mean two points in the DAS44 score after 12 weeks of treatment was similar to the results of the COBRA- light trial. The improvement on RAID was in agreement with the results of the study of Ledingham et al.(31;32). Clinical response and remission definitions in RA are defined in several ways and the stringency of these different definitions has been shown to vary widely and lead to enormous differences in results, which is comparable to our results as 61% reached DAS44 remission, while 27% of the patients achieved Boolean-based remission(33).
Our results showed a similar percentage of agreement between physician- and patient- 7 perceived remission, as in existing literature an agreement between 51% and 79% is seen(5-9). For example, the Danish DANBIO registry found a 51% agreement between
8300 RA patients and physicians. Disagreement in this study was defined as a difference
of >20 mm on the global assessment between the patient and the physician(8). However, the DANBIO registry described patients with a mean disease duration of seven years and patients with lower disease activity, while the current study included patients at the onset of RA, who generally have a higher disease activity. The higher agreement between patients and physicians in the present study was probably due to higher disease activity scores, as a higher swollen joint count is found to be associated with lower odds of discordance(5). This is also visible in the variability of agreement between physicians and patients within different response and remission definitions, as agreement was higher in patients who achieved ACR70 response or Boolean remission. In the present study, both patients and physicians had the best agreement with EULAR good response, which was predictable as (improvement in) DAS is the most commonly used measurement in clinical practice(33).
143