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Patient reported outcome data from the Care in Early Rheumatoid Arthritis trial: Opportunities for broadening the scope of treating to target

Author

Van der Elst K1,2, Verschueren P1,2, Stouten V2, Pazmino S2, De Groef A3,4, De Cock D2, Joly J1, Moons P5,6,7, Westhovens R1,2. Arthritis Care Res (Hoboken). 2019 Apr 5. doi: 10.1002/acr.23900. [Epub ahead of print]

Author Information

1 University Hospitals Leuven, Department of Rheumatology.

2 KU Leuven - University of Leuven, Department of Development and Regeneration, Skeletal Biology and Engineering Research Center.

3 Patient research partner.

4 KU Leuven - University of Leuven, Department of Rehabilitation Sciences and University Hospitals Leuven, Department of Physical Medicine and Rehabilitation.

5 KU Leuven - University of Leuven, Department of Public Health and Primary Care, Academic Center for Nursing and Midwifery, Leuven, Belgium.

6 University of Gothenburg, Institute of Health and Care Sciences, Gothenburg, Sweden.

7 University of Cape Town, Department of Paediatrics and Child Health, Cape Town, South Africa.

Abstract

OBJECTIVE: 

Treating early, intensively and to target leads to rapid disease control, preventing joint damage and loss of function in early rheumatoid arthritis (RA). We report the effect of such approach on patient-reported outcomes and explore the contribution of rapid and persistent disease control on wellbeing after 1 year of treatment.

METHODS: 

This study is part of the Care in early RA trial, a prospective, 2-year, investigator-initiated, randomized controlled trial rooted in daily practice and implementing the treat-to-target principle. SF-36 and IPQ-R data were collected prospectively. We defined 4 clinical response profiles based on speed and consistency of the treatment response within the first year, defined as DAS28CRP<2.6. Linear regression analyses including these response profiles and treatment type were constructed to predict SF-36 dimensions vitality, social functioning, role emotional, mental health, and IPQ-R illness perception subscales consequences, treatment control and illness coherence at year 1.

RESULTS: 

333 patients were available for the main analyses, including 140 early persistent responders. Variation in each of the psychosocial outcomes at year 1 was explained mostly by their baseline values, followed by the clinical response profiles. Patients with an early persistent response reported significantly higher vitality, more positive beliefs about disease consequences and treatment effect. Treatment type did not matter.

CONCLUSION: 

Rapid and persistent disease control and not treatment type was associated with favorable patient reported health and illness perceptions at year 1, but baseline psychosocial variables mattered most. Our data indicate opportunities to broaden the scope of the treat-to-target principle in early RA.