103Gradually, patient-reported outcomes in RA gained momentum as research
studies documented its value in standard clinical practice [ 8 , 9 ]. The new global
trend toward “Patient-Centered Care” has endorsed patient-reported outcomes
measures (PROMs) use in routine healthcare. Effectiveness of care from the
patient’s own perspective, measured by a patient-reported outcome measure,
has become actively involved in quality measurement and service improvement
[ 10 ]. This chapter will highlight the value of PROMs for RA patients, its impact
on both the short-term as well as long-term patients’ management. It will also
discuss patient-reported outcome tools available for RA patients and the differ-
ences amongst them and the possibility of using PROMs as biomarker for RA
patients.
Patient-Reported Outcomes in Rheumatoid Arthritis
Classifying Disease Activity State
Patient-reported outcomes have been investigated in terms of their relations with
the disease activity. Several studies showed their signifi cant association with dis-
ease activity parameters [ 11 – 13 ]. However, as early arthritis and disease remis-
sion became the targets of management, the interest has shifted toward specifi c
patient- reported symptoms such as pain, fatigue, duration of morning stiffness,
quality of life, as well as functional ability. Patient-reported tender joints were
also introduced into standard clinical practice as well as research trials and were
found comparable to the physician-reported joint tenderness [ 14 ]. Assessing
patient global is essential to calculate the disease activity score (DAS-28) [ 15 ].
Similarly, in the American College of Rheumatology core set of disease activity
measures, three elements pertain to the patients’ perspective; these elements are:
pain, functional capacity, and patient global assessment [ 5 ]. The RAPID3 (rou-
tine assessment of patient index data 3) questionnaire incorporates three patient-
reported outcomes from the RA core set (namely pain, function, and patient
global assessment), and this tool has been shown to provide similar information
to clinician-scored indices of disease activity, namely: CDAI (Clinical Disease
Activity Index) = Tender Joint Count, Swollen Joint Count, physician global and
patient global assessment; SDAI (Simplifi ed Disease Activity Index) = Tender
Joint Count, Swollen Joint Count, physician global, patient global assessment as
well as CRP; DAS-28: Disease Activity Scale with 28 joint count = Tender Joint
Count, Swollen Joint Count, CRP, patient global [ 16 ]. The development of multi-
dimensional patient-reported outcome measures, which has been validated [ 6 , 17 ,
18 ], facilitated the inclusion of such parameters in standard day-to-day practice
and paved the way for a more active role for patient involvement in monitoring
their disease activity. This could enhance treatment by providing early warning
when targets are not met and indicating the need for a physician visit to re-evalu-
ate treatment.
4 PROMs for Rheumatoid Arthritis