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Validity and reliability problems with patient global as a component of the ACR/EULAR remission criteria as used in clinical practice.
J Rheumatol. 2012 Jun; 39(6):1139-45.JR

Abstract

OBJECTIVE

To investigate what factors influence patient global health assessment (PtGlobal), and how those factors and the reliability of PtGlobal affect the rate, reliability, and validity of recently published American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) rheumatoid arthritis (RA) remission criteria when used in clinical practice.

METHODS

We examined consecutive patients with RA in clinical practice and identified 77 who met ACR/EULAR joint criteria for remission (≤ 1 swollen joint and ≤ 1 tender joint). We evaluated factors associated with a PtGlobal > 1, because a PtGlobal ≤ 1 defined ACR/EULAR remission in this group of patients who had already met ACR/EULAR joint criteria.

RESULTS

Of the 77 patients examined, only 17 (22.1%) had PtGlobal ≤ 1 and thus fully satisfied ACR/EULAR criteria. A large proportion of patients not in remission by ACR/EULAR criteria had high PtGlobal related to noninflammatory issues, including low back pain, fatigue, and functional limitations, and a number of patients clustered in the range of PtGlobal > 1 and ≤ 2. However, the minimal detectable difference for PtGlobal was 2.3. In addition, compared with a PtGlobal severity score, a PtGlobal activity score was 3.3% less likely to be abnormal (> 1).

CONCLUSION

Noninflammatory factors contribute to the level of PtGlobal and result in the exclusion of many patients who would otherwise be in "true" remission according to the ACR/EULAR definition. Reliability problems associated with PtGlobal can also result in misclassification, and may explain the observation of low longterm remission rates in RA. As currently constituted, the use of the ACR/EULAR remission criteria in clinical practice appears to be problematic.

Authors+Show Affiliations

University of Kansas School of Medicine, Wichita, KA, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22589262

Citation

Masri, Karim R., et al. "Validity and Reliability Problems With Patient Global as a Component of the ACR/EULAR Remission Criteria as Used in Clinical Practice." The Journal of Rheumatology, vol. 39, no. 6, 2012, pp. 1139-45.
Masri KR, Shaver TS, Shahouri SH, et al. Validity and reliability problems with patient global as a component of the ACR/EULAR remission criteria as used in clinical practice. J Rheumatol. 2012;39(6):1139-45.
Masri, K. R., Shaver, T. S., Shahouri, S. H., Wang, S., Anderson, J. D., Busch, R. E., Michaud, K., Mikuls, T. R., Caplan, L., & Wolfe, F. (2012). Validity and reliability problems with patient global as a component of the ACR/EULAR remission criteria as used in clinical practice. The Journal of Rheumatology, 39(6), 1139-45. https://doi.org/10.3899/jrheum.111543
Masri KR, et al. Validity and Reliability Problems With Patient Global as a Component of the ACR/EULAR Remission Criteria as Used in Clinical Practice. J Rheumatol. 2012;39(6):1139-45. PubMed PMID: 22589262.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Validity and reliability problems with patient global as a component of the ACR/EULAR remission criteria as used in clinical practice. AU - Masri,Karim R, AU - Shaver,Timothy S, AU - Shahouri,Shadi H, AU - Wang,Shirley, AU - Anderson,James D, AU - Busch,Ruth E, AU - Michaud,Kaleb, AU - Mikuls,Ted R, AU - Caplan,Liron, AU - Wolfe,Frederick, Y1 - 2012/05/15/ PY - 2012/5/17/entrez PY - 2012/5/17/pubmed PY - 2012/10/4/medline SP - 1139 EP - 45 JF - The Journal of rheumatology JO - J Rheumatol VL - 39 IS - 6 N2 - OBJECTIVE: To investigate what factors influence patient global health assessment (PtGlobal), and how those factors and the reliability of PtGlobal affect the rate, reliability, and validity of recently published American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) rheumatoid arthritis (RA) remission criteria when used in clinical practice. METHODS: We examined consecutive patients with RA in clinical practice and identified 77 who met ACR/EULAR joint criteria for remission (≤ 1 swollen joint and ≤ 1 tender joint). We evaluated factors associated with a PtGlobal > 1, because a PtGlobal ≤ 1 defined ACR/EULAR remission in this group of patients who had already met ACR/EULAR joint criteria. RESULTS: Of the 77 patients examined, only 17 (22.1%) had PtGlobal ≤ 1 and thus fully satisfied ACR/EULAR criteria. A large proportion of patients not in remission by ACR/EULAR criteria had high PtGlobal related to noninflammatory issues, including low back pain, fatigue, and functional limitations, and a number of patients clustered in the range of PtGlobal > 1 and ≤ 2. However, the minimal detectable difference for PtGlobal was 2.3. In addition, compared with a PtGlobal severity score, a PtGlobal activity score was 3.3% less likely to be abnormal (> 1). CONCLUSION: Noninflammatory factors contribute to the level of PtGlobal and result in the exclusion of many patients who would otherwise be in "true" remission according to the ACR/EULAR definition. Reliability problems associated with PtGlobal can also result in misclassification, and may explain the observation of low longterm remission rates in RA. As currently constituted, the use of the ACR/EULAR remission criteria in clinical practice appears to be problematic. SN - 0315-162X UR - https://www.unboundmedicine.com/medline/citation/22589262/Validity_and_reliability_problems_with_patient_global_as_a_component_of_the_ACR/EULAR_remission_criteria_as_used_in_clinical_practice_ L2 - http://www.jrheum.org/cgi/pmidlookup?view=long&pmid=22589262 DB - PRIME DP - Unbound Medicine ER -