Patientrapporteret sygdomsbelastning ved reumatoid artrit En undersøgelse af responsivitet for Rheumatoid Arthritis Impact of Disease

• Main Author: Holten, Karen
• Format: Master Thesis
• Language: Danish
• Published: 2018
• Subjects: Arctic; Ritchie
• Online Access: http://hdl.handle.net/10852/63363; http://urn.nb.no/URN:NBN:no-65925

Sammendrag Formål: Formålet med denne opgave er at undersøge responsiviteten til Rheumatoid Arthritis Impact of Disease (RAID) som mål for selvrapporteret sygdomsbelastning hos patienter med reumatoid artrit. Teoretisk forankring: RAID er et patientrapporteret mål for oplevet sygdomsbelastning. Patientperspektivet anses som vigtigt i og indgår i internationale anbefalinger for behandlingen og opfølgningen af reumatoid artrit (RA). Patientrapporterede udfaldsmål egner sig til at supplere kliniske undersøgelser og inflammatoriske markører i vurderingen af sygdomsaktivitet og effekt af behandling og er udbredt anvendt i klinisk RA-forskning. For at et måleredskab skal opfange ændringer må det være responsivt. Metode: Denne opgave benytter sekundærdata fra ARCTIC-studiet. Tilgangen er kvantitativ. Inklusionskriterierne var RA-diagnose, symptomvarighed under to år, ingen forudgående sygdomsmodificerende behandling, men indikation for opstart. Patienterne blev fulgt i 24 måneder og modtog behandling og opfølgning efter treat-to-target-strategi med sygdomsremision som behandlingsmål. Responsiviteten blev beregnet med standardized response mean (SRM) for RAID-scoren og andre patientrapporterede udfaldsmål, inflammatoriske markører og mål for sygdomsaktivitet efter 3 og 6 måneder. Relative efficiency (RE) blev beregnet for samtlige udfaldsmål i relation til referencen, ømme led ved Ritchie articular index, efter 3 og 6 måneder. Resultater: 230 patienter blev inkluderet. Gennemsnitlig symptomvarighed (SD) og RAID-score (SD) ved baseline var 7.09 (5.40) måneder og 4.49 (2.14). DAS, RAID, PhGA, hævede led (44), ømme led, PROMIS pf-20, PGA, SF-36 PCS og ledsmerte viste høj responsivitet (≥ 0.80). CRP og ESR viste moderat responsivitet og fatigue og SF-36 MCS lav. DAS, PhGA og hævede led viste højest relativ effektivitet i at opfange ændringer. RAID-scoren var mere sensitiv end referencen og lige så effektiv som PGA og ledsmerte. Konklusion: Beregningen af SRM indikerede høj responsivitet i RAID-scoren. RAID-scoren var mere effektiv til at opfange ændringer end referencen, ømme led. RAID-scoren tolkes som responsiv for ændringer i denne kohorte af patienter med kort symptomvarighed. Abstract Purpose: To assess the changes in and evaluate the responsiveness of the patient-reported outcome measure (PROM), Rheumatoid Arthritis Impact of Disease (RAID) score in patients with early rheumatoid arthritis (RA) within the first six months of intensive disease-modifying antirheumatic drug (DMARD) treatment. Literature framework: PROMs provide information about the impact of disease and treatment effect from a patient perspective and supplement conventional disease activity measures and clinical assessments in alignment with the latest recommendations for management of RA. Responsiveness is an important psychometric property in order for a measure to detect change. Method: This quantitative study used data from the Norwegian, 24 months prospective ARCTIC trial. The participants were diagnosed with RA, had symptom duration of less than two years, were DMARD naïve with an indication for treatment. Treatment followed the latest recommendations in a treat-to-target strategy with remission as treatment target. Responsiveness was evaluated using standardized response mean (SRM) and relative efficiency (RE) with respect to tender joints by Ritchie articular index after 3 and 6 months. SRMs and REs were also calculated for other PROMS, inflammatory markers and clinical outcome measures. Results: 230 patients were included. The mean (SD) symptom duration was 7.09 (5.40) months. After 3 months there was a marked treatment response in all parameters. DAS, RAID, tender joints, PROMIS PF-20, joint pain, SF-36 PCS, PhGA, PGA and swollen joints (44) all showed high responsiveness to change (SRM ≥ 0.80). ESR and CRP showed moderate responsiveness to change while fatigue and SF-36 MCS low. DAS, PhGA and swollen joints showed the highest relative efficiencies in detecting change. The RAID score was more efficient than the reference and similar to PGA and joint pain. Conclusion: The RAID score proved to be highly responsive to change in patients with short symptom duration who followed a treat-to-target strategy.