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- Title
Do patient-reported measures of disease activity in rheumatoid arthritis vary between countries? Results from a Nordic collaboration.
- Authors
Delcoigne, Bénédicte; Provan, Sella Aarrestad; Hammer, Hilde Berner; Giuseppe, Daniela Di; Frisell, Thomas; Glintborg, Bente; Grondal, Gerdur; Gudbjornsson, Bjorn; Hetland, Merete Lund; Michelsen, Brigitte; Nordström, Dan; Relas, Heikki; Askling, Johan
- Abstract
Objectives To investigate whether patient-reported outcomes vary across countries and are influenced by cultural/contextual factors. Specifically, we aimed to assess inter-country differences in tender joint count (TJC), pain and patient's global health assessment (PGA), and their impact on disease activity (DAS28-CRP) in RA patients from five Nordic countries. Methods We collected data (baseline, 3- and 12-months) from rheumatology registers in the five countries comprising RA patients starting a first ever MTX or a first ever TNF inhibitor (TNFi). In order to assess the role of context (=country), we separately modelled TJC, pain and PGA as functions of objective variables (CRP, swollen joint count, age, sex, calendar period and disease duration) with linear models. Analyses were performed at each time point and for both treatments. We further assessed the impact of inter-country differences on DAS28-CRP. Results A total of 27 645 RA patients started MTX and 19 733 started a TNFi. Crude inter-country differences at MTX start amounted to up to 4 points (28 points scale) for TJC, 10 and 27 points (0–100 scale) for pain and PGA, respectively. Corresponding numbers at TNFi start were 3 (TJC), 27 (pain) and 24 (PGA) points. All differences were reduced at 3- and 12-months, and attenuated when adjusting for the objective variables. The variation in predicted DAS28-CRP across countries amounted to <0.5 units. Conclusions Inter-country differences in TJC, pain and PGA are greater than expected based on differences in objective measures, but have a small clinical impact on DAS28-CRP across countries.
- Subjects
ICELAND; SWEDEN; DENMARK; FINLAND; NORWAY; EUROPE; PAIN; ANTI-inflammatory agents; HEALTH outcome assessment; WORLD health; REGRESSION analysis; SOCIOECONOMIC factors; RHEUMATOID arthritis; SYMPTOMS; INTERPROFESSIONAL relations; DESCRIPTIVE statistics; JOINTS (Anatomy); MEDICAL needs assessment
- Publication
Rheumatology, 2022, Vol 61, Issue 11, p4286
- ISSN
1462-0324
- Publication type
Article
- DOI
10.1093/rheumatology/keac081