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Discrepancy in Patient-Reported Outcome Measures Between Patients With Recent-Onset SLE and Early RA

Avatar photoSheila Jacobs
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No standardization exists for the use of PRO instruments in clinical practice, and several are used, which measure different outcomes. Most instruments evaluate pain, patient global assessment, and fatigue using a visual analog scale (VAS).5 A systematic review of the literature for articles on PRO instruments in RA published in the past 20 years identified the following instruments as the strongest and most thoroughly validated:12 • Patient-derived Disease Activity Score with 28-joint counts (Pt-DAS28) • Rheumatoid Arthritis Disease Activity Index (RADAI) • RADAI-5 • Routine Assessment of Patient Index Data (RAPID)-5 Rheumatologists are increasingly expected to track PROs in clinical care. More guidance is needed on how to select an instrument for assessing PROs and how to apply the information obtained.3
No standardization exists for the use of PRO instruments in clinical practice, and several are used, which measure different outcomes. Most instruments evaluate pain, patient global assessment, and fatigue using a visual analog scale (VAS).5 A systematic review of the literature for articles on PRO instruments in RA published in the past 20 years identified the following instruments as the strongest and most thoroughly validated:12 • Patient-derived Disease Activity Score with 28-joint counts (Pt-DAS28) • Rheumatoid Arthritis Disease Activity Index (RADAI) • RADAI-5 • Routine Assessment of Patient Index Data (RAPID)-5 Rheumatologists are increasingly expected to track PROs in clinical care. More guidance is needed on how to select an instrument for assessing PROs and how to apply the information obtained.3
Researchers determined the link between patient-reported outcome measure scores and organ damage in patients with recent-onset systemic lupus erythematosus and early rheumatoid arthritis.

A marked discrepancy has been observed between patient-reported outcome measures (PROMs) between patients with recent-onset systemic lupus erythematosus (SLE) and early rheumatoid arthritis (RA), according to study results published in Clinical Rheumatology.

The researchers sought to examine the association between PROM scores and organ damage in patients with recent-onset SLE and those with early RA.

Patients with recent-onset SLE and no prior organ damage from the Clinical Lupus Register in Northeastern Gothia (KLURING), Sweden, University Hospital in Linköping, and those with early RA from the 2nd Timely Interventions in Early RA (TIRA-2) study, Sweden, were included in the current analysis. Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index (SDI) was used to evaluate the incidence of organ damage. Clinical measurements and PROMs at months 0, 6, 12, 24, 36, 48, and 60 were collected. The PROMs were assessed using the visual analog scale (VAS; pain, fatigue, and well-being measures); the Health Assessment Questionnaire (HAQ); and the European Quality of Life 5 Dimensions (EQ-5D-3L).

Patients in the SLE and RA groups had symptoms for less than a 1 year prior to diagnosis, received treatment based on the Swedish national guidelines, and were followed-up prospectively. Patients with RA were included in the comparator group because of the similarities between RA and SLE with respect to disease progression, manifestations, joint involvement, and disability.

The study included 41 patients with recent-onset SLE and 522 patients with early RA.

Results of the study showed that PROMs were worse for patients with RA compared with those with SLE, improving by month 6 following diagnosis. However, SLE PROMs remained stable. In participants with SLE, the incidence of organ damage was 13.6 per 100 patient-years. The SDI was significantly associated with EQ-5D-3L (Pearson correlation coefficient [PCC], -0.48; P =.003), VAS fatigue (PCC, 0.44; P =.009), and VAS well-being (PCC, 0.41; P =.01) at 24 months.

The researchers concluded, “These results highlight the need for improvement in multiprofessional assessment and treatment for patients with SLE.”                                                                                                          

Disclosure: Some of the study authors have declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 

Reference

Heijke R, Björk M, Thyberg I, Kastbom A, McDonald L, Sjöwall C. Comparing longitudinal patient-reported outcome measures between Swedish patients with recent-onset systemic lupus erythematosus and early rheumatoid arthritis. Clin Rheumatol. Published online November 27, 2021. doi:10.1007/s10067-021-05982-3

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