AB0280 DIFFERENCE BETWEEN PATIENT’S GLOBAL HEALTH AND PATIENT‘S GLOBAL ASSESSMENT OF DISEASE ACTIVITY, AND DIFFERENT FACTORS INFLUENCE ON THESE SCALES IN RHEUMATOID ARTHRITIS PATIENTS
Authors: Naohiro Sugitani, Yuki Mizutani, Kentaro Noda, Yasuo Suzuki, Ayako Nakajima
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Evaluation of rheumatoid arthritis (RA) activity is crucial measurement in achieving remission or low disease activity. Visual analogue scale (VAS) by patient's evaluation has been used for the outcome measure for RA patients because of its feasibility, reliability, sensitivity to change, and it directly reflects the patient's overall perspective. Patient's evaluation is a component of multiple composite indices used in assessing RA activity and treatment response. There are two measurements that patient's evaluation. One is patient's global assessment of disease activity (PtGA), and the other is patient's assessment of global health (PtGH)<sup>1)</sup>. PtGA was originally developed as a component of American College of Rheumatology Core Set and used for Simplified Disease Activity Index (SDAI) and Clinical Disease Activity Index (CDAI); while PtGH was originally developed as a component of 28-joint Disease Activity Score (DAS28). PtGA and PtGH have been considered equivalent in a large scale of study<sup>2)</sup>. In daily practice or observation, "patient's VAS" is usually used without specifying whether it refers to PtGA or PtGH. The factors which influence the change in PtGA or PtGH have not been demonstrated concomitantly in daily practice. <h3>Objectives</h3> We investigated the difference between PtGA and PtGH, especially each change obtained after intensification of treatment in 12 weeks and identified the factors that influence on each measurement in RA patients. <h3>Methods</h3> Consecutive patients were enrolled to this retrospective study at our hospital from October 2017 to September 2018. Demographic and clinical data at enrollment as well as treatment regimens were collected by review of medical charts. At first, we examined the baseline data and the changes in 12 weeks of PtGA and PtGH in their relations. The second, we divided those patients into two subsets according to medications intensified by methotrexate (MTX) subset and biological disease-modifying antirheumatic drugs (DMARDs) or janus kinase (JAK) inhibitor (B/J) subset. We compared the difference of the changes in PtGA from the baseline to 12 weeks (ΔPtGA) and those in PtGH (ΔPtGH) between MTX subset and B/J subset. Finally, the logistic regression analysis was performed to identify factors that differently influence for each scale in 12 weeks. <h3>Results</h3> Consecutive 38 RA patients were enrolled. Women were 76%. The median age [IQR] was 66.5 [55-75] years old. Disease duration was 2.5 [1-15] years. DAS28 was 2.61 [2.02-3.17]. SDAI was 16.8 [11.1-24.6] and CDAI was 15.3 [9.38-23.9]. MTX was initiated or increased in 24 patients (63%). The baseline median dose of MTX was 6 [3.5-8] mg/week. Biologics or JAK inhibitor were initiated in 8 patients (21%); tocilizumab (n=5), golimumab (n=1), abatacept (n=1) and tofacitinib (n=1). Other DMARDs were used in 6 patients (16%). ΔPtGH in 12 weeks was -1.68 (p&lt;0.01), and ΔPtGA in 12 weeks was -2.22 (p&lt;0.01). ΔPtGH and ΔPtGA correlated significantly (r=0.785, p&lt;0.01). ΔPtGA in MTX subsets was not different from that in B/J subsets in (p=0.50) and ΔPtGH was not either (p=0.57). No significant improving factor in ΔPtGA was identified, whereas, woman (p&lt;0.05) and usage of steroid (p&lt;0.01) were improving factors in ΔPtGH. <h3>Conclusion</h3> Intensification of treatment significantly improved in both ΔPtGA and ΔPtGH but we need to pay attentions that there were different improving factors between these two patient's measuremet. <h3>References</h3> [1] Koevoets R, et al. Simplified versions of the original disease activity score: validation in BeSt trial. Ann Rheum Dis2011; 70: 1471. [2] Khan NA, et al. Patient's global assessment of disease activity and patient's assessment of general health for rheumatoid arthritis activity assessment: are they equivalent?Ann Rheum Dis2012; 71: 1942. <h3>Disclosure of Interests</h3> Naohiro Sugitani: None declared, Yuki Mizutani: None declared, Kentaro Noda: None declared, Yasuo Suzuki: None declared, Ayako Nakajima Grant/research support from: Asahi Kasei pharma co., Chugai Pharmaceutical, Daiichi Sankyo Co., Pfizer, Kissei Pharmaceutical Co., and Mitsubishi Tanabe Pharma Corporation.