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An association study of disease activity score components and patient satisfaction with overall health for early RA patients on non-biologic DMARD therapy

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Abstract

Patient overall satisfaction with health (PSH) was measured by a subset of questions from the Arthritis Impact Measurement Scales II. Based on longitudinal observations for 267 early rheumatoid arthritis (RA) patients of the United States Western Consortium (WC) cohort receiving first non-biologic DMARD treatment, we estimated the 1-year change in PSH (\(\Updelta\) PSH). Logistic regression analysis was used to estimate the association of improvement in \(\Updelta\) PSH with the core set of clinical and patient-reported components of disease activity scores (DAS). Most patients were more satisfied with health after 1 year of treatment (80%); few achieved DAS28-ESR minimal disease activity (27%) or remission (7%). Laboratory and joint count measures were not associated with improved 12-month PSH. Patients with greater HAQ-DI (P = 0.0473) and self-reported stiffness (P = 0.0669) were more likely to have a perceived overall health benefit from treatment. Regardless of objective disease status, patients are generally satisfied with first-line treatment, which could present a challenge to implementing DAS-guided treatment change. Patients with greater self-reported functional limitations might have lower expectations for treatment benefit and be less willing to modify their current therapy; subjective assessments of function and stiffness could be particularly useful in identifying these patients.

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Abbreviations

AIMS2:

Arthritis Impact Measurement Scales II

CDAI:

Clinical Disease Activity Index

CRP:

C-reactive protein

DAS:

Disease activity score

DMARD:

Disease-modifying anti-rheumatic drug

ESR:

Erythrocyte sedimentation rate

HAQ-DI:

Health Assessment Questionnaire-Disease Index

MDA:

Minimal disease activity

PSH:

Patient overall satisfaction with health

RA:

Rheumatoid arthritis

VAS:

Visual analog scale

WC:

Western Consortium

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Acknowledgments

The Western Consortium of Practicing Rheumatologists: J. Javier Orozco-Alcala, MD (Guadalajara, Mexico); Karen Basin, MD (Medford, OR); Martin Berry, MD (Bakersfield, CA); Charles Boniske, MD (Visalia, CA); Melvin Britton, MD (Palo Alto, CA); Ken Bulpitt, MD (Torrance, CA); Jeffrey Carlin, MD (Seattle, WA); H. Walter Emori, MD (Medford, OR); Robert Ettlinger, MD (Tacoma, WA); Daniel Furst, MD (Seattle, WA, now in Los Angeles, CA); Gregory Gardner, MD (Seattle, WA); Robert Gerber, MD (Medford, OR); Maria Greenwald, MD (Palm Desert, CA); Karen Kolba, MD (Santa Maria, CA); George Krick, MD (Tacoma, WA); Max Lundberg, MD (Sandy, UT); Anne MacGuire, MD (Casper, WY); Philip Mease, MD (Seattle, WA); Ghislaine Bernard Medina, MD (Guadalajara, Mexico); Raymond Mirise, MD (Los Angeles, CA, now in Glendale, AZ); Ina Oppliger, MD (Seattle, WA, now in Kansas City, MO); Allen Sawitzke, MD (Salt Lake City, UT); Gerald Schoepflin, MD (Portland, OR); John Seaman, MD (Seattle, WA, now in Tacoma, WA); Robert Shapiro, MD (Sacramento, CA); Fredrica Smith, MD (Los Alamos, CA); Marcia Sparling, MD (Vancouver, WA); Elizabeth Tindall, MD (Portland, OR); Michael Weisman, MD (San Diego, CA, now in Los Angeles, CA); Mark Wener, MD (Seattle, WA); Craig Wiesenhutter, MD (Coeur dAlene, ID); Kenneth Wiesner, MD (Sacramento, CA); Robert Willkens, MD (Seattle, WA); Kenneth Wilske, MD (Seattle, WA); Andrew Wong, MD (Northridge, CA); George Young, MD (Boulder, CO). Thank you to Paul Maranian for his assistance with the data analysis. This research was supported by a National Institutes of Health/National Institute of Allergy and Infectious Diseases training grant T32-AI007370.

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Authors and Affiliations

  1. Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, EPS 8044, Rockville, MD, 20892, USA

    Stephanie A. Kovalchik

  2. Division of Rheumatology, University of California at Los Angeles, 1000 Veteran Avenue, Rehabilitation Building, Los Angeles, CA, 90095, USA

    Christina Charles-Schoeman, Dinesh Khanna & Harold E. Paulus

Authors
  1. Stephanie A. Kovalchik
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  2. Christina Charles-Schoeman
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  3. Dinesh Khanna
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  4. Harold E. Paulus
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Correspondence to Stephanie A. Kovalchik.

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Kovalchik, S.A., Charles-Schoeman, C., Khanna, D. et al. An association study of disease activity score components and patient satisfaction with overall health for early RA patients on non-biologic DMARD therapy. Rheumatol Int 32, 2725–2729 (2012). https://doi.org/10.1007/s00296-011-2037-1

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