Impact of patient global assessment on achieving remission in patients with rheumatoid arthritis: a multinational study using the METEOR database

OBJECTIVES: There is an on-going debate about excluding patient global assessment (PGA) from composite and Boolean-based definitions of rheumatoid arthritis (RA) remission. This study aimed at i) determining the influence of PGA on RA disease states, exploring differences across countries, and ii) understanding the association between PGA, measures of disease impact (symptoms) and markers of disease activity (inflammation). METHODS: Cross-sectional data from the METEOR international database were used. We calculated the proportion of patients failing ACR/EULAR Boolean-based remission (4v-remission) solely due to PGA (PGA-near-remission) in the overall sample and in the most representative countries (i.e. with over 3,000 patients in the database). Multivariable linear regression models were used to identify the main determinants of PGA, grouped in (predominantly) inflammatory (28-tender and 28-swollen joint counts and C-reactive protein) and disease impact factors (pain and function). RESULTS: This study included 27,768 patients. Excluding PGA from the Boolean-based definition (3v-remission) increased remission rate from 5.8% to 15.8%. The rate of PGA-near-remission varied considerably between countries, from 1.7% in India to 17.9% in Portugal. One third of patients in PGA-near-remission scored PGA>4/10. Pain and function were the main correlates of PGA, with inflammation-related variables contributing less to the model (R2 =0.57). CONCLUSIONS: PGA is moderately related to joint inflammation overall, but only weekly so in low levels of disease activity. A considerable proportion of patients otherwise in biological remission still perceive high PGA, putting them at risk of excessive immunosuppressive treatment. This article is protected by copyright. All rights reserved