Performance of patient-reported outcomes in the assessment of rheumatoid arthritis disease activity:the experience of the ESPOIR cohort.

OBJECTIVES: Rheumatoid arthritis (RA) activity can be assessed by several outcome measures. The importance of patient-reported outcomes (PROs) has recently been advocated. Our objective was to determine whether patient self-assessment can reflect RA disease activity. METHODS: Data from patients included in the early arthritis ESPOIR cohort and fulfilling 2010 ACR/EULAR criteria for RA at month 12 were used. Data for several PROs (visual analogue scale for fatigue, pain, patient assessment of disease activity; Health Assessment Questionnaire [HAQ]; Medical Outcomes Study Short Form 36 [SF36]; Echelle de Mesure de l'Impact de la polyarthrite Rhumatoïde-court [EMIR-court] and Routine Assessment of Patient Index Data 3 [RAPID3]) were collected and their association with disease activity measured by Disease Activity Score in 28 joints-3 variables (DAS28-3v) was assessed. The association of PROs and disease activity was assessed by explained variance, Pearson correlation and performance of each PRO in differentiating low versus high disease activity states. RESULTS: We evaluated data for 677 patients. Whatever the disease activity, less impaired PROs was associated with the lowest disease activity. All PROs were moderately correlated with RA disease activity. The RAPID3 had the best association with DAS28-3v in determining RA disease activity state (r=0.45-0.55, explained variance 30-45%, sensitivity 69-100% and specificity 55-78%). Global PROs (RAPID3, EMIR-court) had the highest association with disease activity, followed by PROs assessing physical function. CONCLUSIONS: The association of PROs and RA disease activity (DAS28-3v) remains moderate. RAPID3, a global PRO, had the best association with disease activity as compared with other analysed PROs.

Assessment of MRI abnormalities of the sacroiliac joints and their ability to predict axial spondyloarthritis: a retrospective pilot study on 110 patients.

OBJECTIVE: To assess sacroiliac joint (SIJ) modifications on MRI and their ability to predict axial spondyloarthritis (SpA) with the purpose of identifying parameters for future prospective studies. METHODS: Retrospective study was carried out of 110 consecutive patients referred for SIJ MRI with coronal, axial short TI inversion recovery (STIR), and axial T1 sequences over 6 months. Factors associated with SpA, including MRI SIJ modifications (fat deposition, structural abnormalities on T1-weighted images, and bone marrow edema [BME] on STIR sequences) and age were explored using multivariate logistic regression. The reference diagnosis was made 1-1.5 years later based on clinical, radiological, and biological findings, according to Assessment of SpondyloArthritis International Society (ASAS) criteria. RESULTS: Twenty-eight patients were diagnosed with SpA (female/male: 19/9, age 41 ± 13 years). Abnormal findings were found in up to 21 % of patients without SpA (including 11 % with BME), versus 64 % of SpA patients (50 % with BME). A threshold age of 42.6 years was found to discriminate SpA patients (ROC AUC: 0.71, 95 % CI: 0.59-0.81). BME location in the sacral (OR: 7.07 [1.05, 47.6], p = 0.044) and both sacral and iliac areas (OR: 36.0 [5.61, 231], p = 0.0002), as well as age (OR: 0.95 [0.92, 0.98], p = 0.0019) were found to be independent predictors of SpA. 83.6 % of patients were effectively diagnosed using BME location and patient age in a classification and regression tree (CART) algorithm (sensitivity: 61 %, specificity: 91 %, PPV: 71 %, NPV: 87 %). CONCLUSION: The BME location combined with the patient's age (threshold 42.6 years) could help predict SpA. Further studies are required before these features can be used by radiologists to boost their confidence in reporting SIJ MRI.

Defining erosive disease typical of RA in the light of the ACR/EULAR 2010 criteria for rheumatoid arthritis; results of the data driven phase.

BACKGROUND: According to the 2010 criteria, rheumatoid arthritis (RA) can be classified in the presence of ≥6 points on the criteria or 'typical' erosive disease. RA-specific erosiveness however has not been defined yet. This study reports the results of the data driven phase of a European League Against Rheumatism (EULAR) taskforce aiming to define RA-specific erosiveness. METHODS: Baseline radiographs of hands and feet of 980 Dutch and 811 French early arthritis patients were studied on the number and site of erosive joints. Test characteristics were determined, with the outcome measures being initiation of methotrexate (MTX) therapy or any disease modifying antirheumatic drug (DMARD) therapy within the first year of disease and arthritis persistency over 5 years. Analyses were repeated in the patients with <6 points on the American College of Rheumatology/EULAR 2010 criteria. RESULTS: In both cohorts comparable test characteristics were observed for the outcomes MTX therapy, any DMARD therapy and arthritis persistency. Test characteristics were not influenced by the site of erosiveness. The specificity observed was >50% for ≥1 erosive joint, >80% for ≥3 erosive joints and >90% for ≥5 erosive joints. When analysing the patients not fulfilling the 2010 criteria (n=308 and 149), specificity was >60% for ≥1 erosive joint, >90% for ≥3 erosive joints and >95% for ≥5 erosive joints. Few of these patients fulfilled the radiological criterion; 27-36 patients had ≥3 erosive joints and 13-14 patients had ≥5 erosive joints. CONCLUSIONS: RA-specific erosiveness can be defined with high specificity at several cut-offs for the number of erosive joints in two independent cohorts with multiple different outcomes. The final radiological criterion will be established in the next phase.