104
Prognostic Marker
The introduction of the early arthritis concept and the “window of opportunity”
widened the scope to include disease parameters to help identify the patient
subgroup suffering from persistent infl ammatory arthritis. The EPISA study [ 19 ],
carried out to predict persistent infl ammatory arthritis disease course, identifi ed
duration of morning stiffness, deterioration of functio nal disability over 3
months, as well as anti-cyclic citrullinated peptide (CCP) antibodies as the three
main poor prognostic manifestations in this subgroup of patients. This impor-
tant role of functional disability was also highlighted by studies that linked
increased mortality to greater functional disability in arthritis patients [ 20 ].
Recently, the American College of Rheumatology guidelines (2015) for man-
agement of infl ammatory arthritis [ 21 ] identifi ed functional disability, seroposi-
tivity for rheumatoid factor or anti-CCP, presence of bony erosions, as well as
the presence of extra-articular manifestations as poor prognostic features in
arthritic patients.
The discrepancy between the clinicians and the patient global assessment espe-
cially early in the disease course can be attributed to the fact that both clinicians
and patients have different perspectives on outcomes. A recent study [ 22 ] was
carried out aiming at assessment of the concurrence and non-concurrence of
patient and physician global assessment in early rheumatoid arthritis patients both
in disease activity and in remission. Retrospective analysis of 480 patients diag-
nosed according to the 2010 ACR/EULAR criteria [ 23 ] for early infl ammatory
arthritis revealed that global estimates of both patients and physicians vary
according to disease activity status. In patients with moderate to highly active
disease (DAS-28 > 3.2), the mean patient global assessment score was signifi -
cantly higher than the physician global score, whereas in disease remission, there
was no signifi cant difference. Furthermore, results revealed that parameters such
as sleep, fatigue, self- helplessness, and work ability had a signifi cant impact on
the patients with active disease and should be considered by the treating physi-
cian. Whilst the health assessment questionnaire (HAQ) assesses the patients’
functional ability, quality of life assessment should be also added to the standard
clinical assessment.
A Potential Disease-Modifying Role
Recording patient-reported outcomes has traditionally been looked at as a one-
stop assessment. In relation to the patient's ever-changing condition characteristic
for RA, recording PROMs at each patient’s visit adds to its dynamic plasticity.
This highlights the importance of keeping a record of these outcomes over longer
periods of time for further analysis. A re cent study [ 24 ] looked into sharing the
Y. El Miedany