Background

Currently, patients with rheumatoid arthritis (RA) require frequent consultations to monitor their disease activity. However, since a majority of patients is in remission during routine follow up, it should be possible to reduce the number of consultations for them.¹ Patients that are meeting their treatment goal, based on the results of their electronic patient reported outcome measures (ePROMs), could be eligible to skip their visit. Research revealed that patients who indicate to be in remission or have a low disease activity (remission/LDA) on their ePROMs, such as the routine assessment of patient index data (RAPID3), also have a low disease activity score 28 (DAS28).² However, in clinical practice the decision to intensify treatment is more complex than not meeting a DAS28 threshold. Therefore, ePROM-results should be compared with treatment intensifications to assess the safety of screening with ePROMs.

Objectives

To assess the probability that patients with low scores on disease activity assessment with ePROMs do not need medication intensification.

Methods

This retrospective study compared results of three ePROMs (RAPID3, patient acceptable symptom state (PASS) and asking patients if they experienced a flare (flare question)) answered during routine care with (disease modifying anti-rheumatic drug) DMARD or steroid intensifications collected from anonymised electronic medical records at Reade. We calculated the positive predictive value (PPV) for not receiving a DMARD or steroid intensifications within two weeks and three months for 1) being in remission/LDA according to the RAPID3, 2) being in PASS and 3) not reporting a flare. The secondary aim of the study was to assess which combination of ePROM-results led to the best PPV for DMARD or steroid intensifications.

Results

A total of 321 records were included that regarded 302 unique patients (77% female, mean age (SD) was 60 (12) years). The PPV for not receiving a DMARD or steroid intensification within 2 weeks of the RAPID3, PASS and flare-question were 99%, 95% and 83%, respectively, and after 3 months 95%, 88%, 85%, for all test characteristics see Table 1. The combination of a RAPID3 < 2 and a negative flare-question resulted in a PPV of 100%; this combination was present in 29% (93/321) of the total study population.

Conclusion

Our results show that the RAPID3, PASS and flare have a high diagnostic accuracy to identify individuals that will not receive a DMARD or steroid intensification up to 3 months after their initial consultation and are therefore possibly eligible to skip their outpatient clinic visit. The combination of the RAPID3 and the PASS yielded the best combination of diagnostic accuracy and highest number of eligible patients.

References

[1]Haugeberg, G. et al. Ten years of change in clinical disease status and treatment in rheumatoid arthritis: results based on standardized monitoring of patients in an ordinary outpatient clinic in southern Norway. Arthritis Res Ther 17, 219 (2015). [2]Wiegel J. et al. Reducing the Number of Outpatient Clinic Visits by Using the Routine Assessment of Patient Index Data 3 as a Screening Tool [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 10).

Disclosure of Interests

None declared

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