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Associations between clinical metrics of joint deformity, disease duration, disease activity, functional capacity, quality of life, pain, and fatigue in patients with rheumatoid arthritis

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Abstract

Objectives

Aim of this study is to clarify associations between metrics of patient’s clinical status statistically using retrospective cohort data.

Methods

Patients with RA who were followed up more than 3 years were recruited. Their EuroQol-5th dimension (EQ5D) as an index of quality of life (QOL), Health Assessment Questionnaire Disability Index (HAQ) as an index of functional capacity (FC), simplified disease activity index (SDAI), pain score using visual analog scale (PS-VAS), and fatigue score using visual analog scale (FS-VAS) were monitored every three months. Sharp/van der Heijde score (SHS) was calculated annually. Associations between average values of these factors at beginning of follow-up (baseline) and change from baseline to final year in follow-up (change), and patient’s sex, age, and disease duration (DD) were evaluated statistically.

Results

A total of 447 patients were analyzed. EQ5D score correlated significantly with HAQ score both at baseline and change of that, and FS-VAS. HAQ score correlated significantly with EQ5D and HAQ score at baseline. SDAI score correlated significantly with SHS and FS-VAS at baseline. SHS correlated significantly with the SHS at baseline. PS-VAS correlated significantly with the PS-VAS, EQ5D at baseline, change of theEQ5D and HAQ scores. FS-VAS correlated significantly with change of the EQ5D score and FS-VAS at baseline.

Conclusions

These results suggested that these clinical metrics are influenced by each variable at baseline. QOL and fatigue are correlated each other, as well as QOL and FC, whereas disease activity correlated with joint deformity level and fatigue.

Key Points

• It is questionable whether improvement of disease activity leads to improvements in functional capacity and QOL in treating rheumatoid arthritis.

• We evaluated the association among metrics of clinical outcomes, such as EQ5D, HAQ, SDAI, SHS, pain score, and fatigue score using retrospective cohort data.

• Results suggested that metrics are influenced by each items at baseline, and QOL and fatigue are correlated each other, as well as QOL and functional capacity.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Smolen JS, Aletaha D, Bijlsma JW, Breedveld FC, Boumpas D, Burmester G et al (2010) Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis 69:631–637. https://doi.org/10.1136/ard.2009.123919

    Article  PubMed  Google Scholar 

  2. Vermeer M, Kuper HH, Hoekstra M, Haagsma CJ, Posthumus MD, Brus HL et al (2011) Implementation of a treat-to-target strategy in very early rheumatoid arthritis: results of the Dutch Rheumatoid Arthritis Monitoring remission induction cohort study. Arthritis Rheum 63:2865–2872. https://doi.org/10.1002/art.30494

    Article  PubMed  Google Scholar 

  3. Gilek-Seibert K, Prescott K, Kazi S (2013) Outcome assessments in rheumatoid arthritis. Curr Rheumatol Rep 15:370. https://doi.org/10.1007/S11926-013-0.70-y

    Article  PubMed  Google Scholar 

  4. Ramiro S, Landewé RB, van der Heijde D, Sepriano A, FitzGerald O, Ostergaard M et al (2020) Is treat-to-target really working in rheumatoid arthritis A longitudinal analysis of a cohort of patients treated in daily practice (RA BIODAM). Ann Rheum Dis 79:453–9. https://doi.org/10.1136/annrheumdis-2019-216819

    Article  PubMed  Google Scholar 

  5. Vermeer M, Kuper HH, Moens HJ, Drossaers-Bakker KW, van der Bijl AE, van Riel PL et al (2013) Sustained beneficial effects of a protocolized treat-to-target strategy in very early rheumatoid arthritis: three-year results of the Dutch Rheumatoid Arthritis Monitoring remission induction cohort. Arthritis Care Res (Hoboken) 65:1219–1226. https://doi.org/10.1002/acr21984

    Article  CAS  PubMed  Google Scholar 

  6. Kaneko Y, Kondo H, Takeuchi T (2013) American College of Rheumatology/European League Against Rheumatism remission criteria for rheumatoid arthritis maintain reliable performance when evaluated in 44 joints. J Rheumatol 40:1254–1258. https://doi.org/10.3899/jrheum.130166

    Article  PubMed  Google Scholar 

  7. Spinella A, Sandri G, Carpenito G, Belletti L, Mascia MT (2012) The discrepancy between clinical and ultrasonographic remission in rheumatoid arthritis is not related to therapy or autoantibody status. Rheumatol Int 32:3917–3921. https://doi.org/10.1007/s00296-011-2259-2

    Article  CAS  PubMed  Google Scholar 

  8. Furu M, Hashimoto M, Ito H, Fujii T, Terao C, Yamakawa N et al (2014) Discordance and accordance between patient’s and physician’s assessments in rheumatoid arthritis. Scand J Rheumatol 43:291–295. https://doi.org/10.3109/03009742.2013.869831

    Article  CAS  PubMed  Google Scholar 

  9. Endo Y, Kawashiri SY, Nishino A, Okamoto M, Tsuji S, Shimizu T et al (2021) Discrepancy between clinical and ultrasound remissions in rheumatoid arthritis: a multicentre ultrasound cohort study in Japan. Scand J Rheumatol 50:436–441. https://doi.org/10.1080/03009742.2021.1876914

    Article  CAS  PubMed  Google Scholar 

  10. Nakabo S, Tsuji Y, Inagaki M, Tsuji H, Nakajima T, Murakami K et al (2021) Severe joint deformity and patient global assessment of disease are associated with discrepancies between sonographic and clinical remission: a cross-sectional study of rheumatoid arthritis patients. Mod Rheumatol 31:334–342. https://doi.org/10.1080/14397595.2020.1751922

    Article  PubMed  Google Scholar 

  11. Vastesaeger N, Xu S, Aletaha D, St Clair EW, Smolen JS (2009) A pilot risk model for the prediction of rapid radiographic progression in rheumatoid arthritis. Rheumatology (Oxford) 48:1114–1121. https://doi.org/10.1093/rheumatology/kep155

    Article  CAS  PubMed  Google Scholar 

  12. Carvajal Alegria G, Milin M, Gandjbakhch F, Saraux A, Bailly F, Jousse-Joulin S et al (2020) A simplified radiographic score effectively predicts radiographic progression of early arthritis in a large nationwide French cohort. Rheumatology (Oxford) 59:1566–1573. https://doi.org/10.1093/rheumatology/kez450

    Article  PubMed  Google Scholar 

  13. Vanier A, Smolen JS, Allaart CF, Van Vollenhoven R, Verschueren P, Vastesaeger N et al (2020) An updated matrix to predict rapid radiographic progression of early rheumatoid arthritis patients: pooled analyses from several databases. Rheumatology (Oxford) 59:1842–1852. https://doi.org/10.1093/rheumatology/kez452

    Article  CAS  PubMed  Google Scholar 

  14. Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO 3rd et al (2010) 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum 62:2569–2581. https://doi.org/10.1002/art.27584

    Article  PubMed  Google Scholar 

  15. Igarashi A, Akazawa M, Murata T, Taguchi T, Sadosky A, Ebata N et al (2015) Cost-effectiveness analysis of pregabalin for treatment of chronic low back pain in patients with accompanying lower limb pain (neuropathic component) in Japan. Clinicoecon Outcomes Res 7:505–520. https://doi.org/10.2147/CEOR.S89833

    Article  PubMed  PubMed Central  Google Scholar 

  16. Smolen JS, Landewé R, Breedveld FC, Buch M, Burmester G, Dougados M et al (2014) EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Ann Rheum Dis 73:492–509. https://doi.org/10.1136/annrheumdis-2013-204573

    Article  CAS  PubMed  Google Scholar 

  17. Smolen JS, Landewé R, Bijlsma J, Burmester G, Chatzidionysiou K, Dougados M et al (2017) EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis 76:960–977. https://doi.org/10.1136/annrheumdis-2016-210715

    Article  PubMed  Google Scholar 

  18. Smolen JS, Landewé RBM, Bijlsma JWJ, Burmester GR, Dougados M, Kerschbaumer A et al (2020) EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Ann Rheum Dis 79:685–99 (annrheumdis-2019-216655)

    Article  CAS  PubMed  Google Scholar 

  19. Japan College of Rheumatology (2020) Japan College of Rheumatology clinical practice guidelines for the management of rheumatoid arthritis. In: Harigai M et al (2021) 2020 Japan College of Rheumatology clinical practice guidelines for the management of rheumatoid arthritis. 1st edn. Shindan to Chiryo Sha, Tokyo, pp16–171

  20. Izawa N, Hirose J, Fujii T, Oka H, Uehara K, Naito M et al (2019) The utility of 25-question Geriatric Locomotive Function Scale for evaluating functional ability and disease activity in Japanese rheumatoid arthritis patients: a cross-sectional study using NinJa database. Mod Rheumatol 29:328–334. https://doi.org/10.1080/14397595.2018.1457422

    Article  PubMed  Google Scholar 

  21. Yamanaka H, Tanaka E, Nakajima A, Furuya T, Ikari K, Taniguchi A et al (2020) A large observational cohort study of rheumatoid arthritis, IORRA: providing context for today’s treatment options. Mod Rheumatol 30:1–6. https://doi.org/10.1080/14397595.2019.1660028

    Article  PubMed  Google Scholar 

  22. Aletaha D, Funovits J, Smolen JS (2008) The importance of reporting disease activity states in rheumatoid arthritis clinical trials. Arthritis Rheum 58:2622–2631. https://doi.org/10.1002/art.23733

    Article  PubMed  Google Scholar 

  23. Smolen JS, Aletaha D, Barton A, Burmester GR, Emery P, Firestein GS et al (2018) Rheumatoid arthritis. Nat Rev Dis Primers 4:18001. https://doi.org/10.1038/nrdp.2018.1

    Article  PubMed  Google Scholar 

  24. Vita AJ, Terry RB, Hubert HB, Fries JF (1998) Aging, health risks, and cumulative disability. N Engl J Med 338:1035–1041. https://doi.org/10.1056/NEJM199804093381506

    Article  CAS  PubMed  Google Scholar 

  25. Krishnan E, Sokka T, Häkkinen A, Hubert H, Hannonen P (2004) Normative values for the Health Assessment Questionnaire disability index: benchmarking disability in the general population. Arthritis Rheum 5:953–960. https://doi.org/10.1002/art.20048

    Article  Google Scholar 

  26. Sokka T, Häkkinen A, Kautiainen H, Maillefert JF, Toloza S, Mørk Hansen T et al (2008) Physical inactivity in patients with rheumatoid arthritis: data from twenty-one countries in a cross-sectional, international study. Arthritis Rheum 59:42–50. https://doi.org/10.1002/art.23255

    Article  PubMed  Google Scholar 

  27. Keystone EC, Taylor PC, Tanaka Y, Gaich C, DeLozier AM, Dudek A et al (2017) Patient-reported outcomes from a phase 3 study of baricitinib versus placebo or adalimumab in rheumatoid arthritis: secondary analyses from the RA-BEAM study. Ann Rheum Dis 76:1853–1861. https://doi.org/10.1136/annrheumdis-2017-211259

    Article  CAS  PubMed  Google Scholar 

  28. Yoshii I, Chijiwa T, Sawada N (2018) Influence of pain score measured by a visual analog scale (PS-VAS) on the Health Assessment Questionnaire Disability Index and 28-joint Disease Activity Index with C-reactive protein in rheumatoid arthritis patients. Int J Rheum Dis 21:1955–1961. https://doi.org/10.1111/1756-185X.13351

    Article  PubMed  Google Scholar 

  29. Yoshii I, Chijiwa T, Sawada N (2019) Validity of adopting a Health Assessment Questionnaire Disability Index less than 0.5 as a target in elderly rheumatoid arthritis patients. Clin Rheumatol 38:3351–3360. https://doi.org/10.1007/s10067-019-04692-1

    Article  PubMed  Google Scholar 

  30. Kastbom A, Roos Ljungberg K, Ziegelasch M, Wetterö J, Skogh T, Martinsson K (2018) Changes in anti-citrullinated protein antibody isotype levels in relation to disease activity and response to treatment in early rheumatoid arthritis. Clin Exp Immunol 194:391–399. https://doi.org/10.1111/cei.13206

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Bondt A, Hafkenscheid L, Falck D, Kuijper TM, Rombouts Y, Hazes JMW et al (2018) ACPA IgG galactosylation associates with disease activity in pregnant patients with rheumatoid arthritis. Ann Rheum Dis 77:1130–1136. https://doi.org/10.1136/annrheumdis-2018-212946

    Article  CAS  PubMed  Google Scholar 

  32. Yee A, Webb T, Seaman A, Infantino M, Meacci F, Manfredi M et al (2015) Anti-CarP antibodies as promising marker to measure joint damage and disease activity in patients with rheumatoid arthritis. Immunol Res 61:24–30. https://doi.org/10.1007/s12026-014-8560-x

    Article  CAS  PubMed  Google Scholar 

  33. Reed E, Hedström AK, Hansson M, Mathsson-Alm L, Brynedal B, Saevarsdottir S et al (2020) Presence of autoantibodies in “seronegative” rheumatoid arthritis associates with classical risk factors and high disease activity. Arthritis Res Ther 22:170. https://doi.org/10.1186/s13075-020-02191-2

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

Authors would like to thank Kaoru Kuwabara, Sayori Masuoka, Eri Morichika, and Aoi Yoshida for their dedicated data collection. The authors would also like to thank Enago (www.enago.jp) for the enthusiastic English language review.

Author information

Authors and Affiliations

  1. Department of Musculoskeletal Medicine, Yoshii Hospital, 6-7-5 Nakamura-Ohashidori, Shimanto City, Kochi, 787-0033, Japan

    Ichiro Yoshii

  2. Department of Rheumatology, Dohgo Onsen Hospital Rheumatology Center, 21-21 Himetsuka Otsu, Matsuyama, Ehime Prefecture, 790-0858, Japan

    Naoya Sawada

  3. Department of Rheumatology, Kochi Memorial Hospital, 4-13 Shiromi-Cho, Kochi, Kochi Prefecture, 780-0824, Japan

    Tatsumi Chijiwa

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  1. Ichiro Yoshii
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Contributions

IY: conceptualization, part of methodology, software, validation, formal analysis, investigation, resources, data curation, writing—original draft, visualization, project administration. NS: recorded data. TC: recorded data. All authors have read the manuscript and agreed with the content.

Corresponding author

Correspondence to Ichiro Yoshii.

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Ethics approval and consent to participate

This study was approved by Yoshii Hospital ethics committee (approval number: YH-RA-2022–1) in accordance with the ethical standards laid down in 1964 Declaration of Helsinki and its later amendments. In addition, anonymity was ensured for all patients and their families who participated in this study, and no names, and/or addresses were issued that could help identify these individuals.

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Yoshii, I., Sawada, N. & Chijiwa, T. Associations between clinical metrics of joint deformity, disease duration, disease activity, functional capacity, quality of life, pain, and fatigue in patients with rheumatoid arthritis. Clin Rheumatol 42, 1027–1038 (2023). https://doi.org/10.1007/s10067-022-06432-4

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