Page 156 - THE EVOLUTION OF EARLY ARTHRITIS AND CARDIOVASCULAR RISK Samina A. Turk

CHAPTER 8
ABSTRACT
OBJECTIVE. Rheumatoid arthritis (RA) patients identified a return to normal as one of the three major themes of remission. Therefore, this study investigated the relationship between patient perceived concepts of normality and remission, and the ability of a ‘normality scale’ to discriminate between remission and non-remission states.
METHODS. Newly diagnosed RA patients with a high disease activity or unfavourable prognostic factors, received treat-to-target combination therapy. At baseline, week 13 and week 26, disease impact was assessed, including a scale measuring the perception of normality (score 7-35, higher scores indicating higher feelings of normality), Disease Activity Score of 28 joints, and two definitions of remission: 1. patient perceived remission (“Would you say that, at this moment, your disease activity is as good as gone?”); 2. ACR/EULAR Boolean remission.
RESULTS. Forty-seven patients completed all assessments: 34 (72%) females, mean±SD age 50±14 years. Normality score at baseline was 20±7, and increased significantly to 23±8 in week 13 and to 24±8 in week 26 (both, p≤0.001). Compared to patients not in remission, patients in remission felt more normal: this was significant for patients in self-perceived remission at week 13 (p<0.001) and week 26 (p=0.007), and for patients in Boolean remission at week 26 (p<0.001).
CONCLUSION. Patients in self-perceived remission felt more normal after 13 and 26 weeks; patients in Boolean remission only after 26 weeks of therapy. The normality scale discriminates between patients in and not in remission, and aligns with patient- perceived remission. Further research is needed to study normality as a patient-relevant target of RA treatment.
154