107when RA treatment causes or contributes to comorbidity development; e.g., steroids
and infection. Finally, type-VI comorbidity (common external factor) occurs when
a common condition leads both to RA and the comorbidity; e.g., smoking, RA, and
lung cancer [ 37 ]. The potential role of PROMs in the assessment of comorbidities
in arthritic patients is an example of the PROMs’ dynamic nature [ 38 ]. Recent
PROMs questionnaires allow the treating clinician to assess for RA-associated
comorbidities at each visit. In its early stages, infl ammatory arthritis patients may
not have signifi cant comorbidities that warrant further management. However, as
the disease progresses and becomes more active, the patient can be prone to 1 or
more of these comorbidities. Screening for these symptoms is highly recommended
on a regular basis for every patient. Furthermore, this approach would also facilitate
on-the-spot assessment for cardiovascular risk, falls risk, osteoporosis as well as
depression [ 39 ]. This dynamic impact of PROMs plays an important role on the
long-term patients’ care.
Patient-Reported Outcome Measures for Rheumatoid
Arthritis
Quantitative measurement in many rheumatic diseases has progressed following
two inspiring conferences held in 1982 [ 40 , 41 ], which endorsed proposals for out-
come measures assessment in rheumatoid arthritis [ 4 , 15 , 32 , 42 – 45 ]; osteoarthritis
[ 46 ]; fi bromyalgia [ 47 ]; systemic lupus erythematosus [ 48 – 53 ]; ankylosing spondy-
litis [ 54 , 55 ]; as well as vasculitis [ 56 – 58 ]. However, unfortunately, most rheuma-
tology patient care continues to run largely without quantitative measures other than
laboratory tests, which may not be available at the time of a patient visit and often
give false-positive or false-negative results [ 59 , 60 ].
According to Bowling [ 61 ], PROMs can be stratifi ed in terms of their disease
specifi city (generic or disease-specifi c), measurement objectives (discrimination,
evaluation, and prediction) and what they intend to measure (quality of life, health-
related quality of life, or health status) [ 62 , 63 ]. The multidimensional measurement
scale involves more than one item of these outcome measures and therefore can be
categorized broadly into two main categories: generic health status and condition-
specifi c measures. Generic instruments comprise items intended to be relevant to
the widest range of patients’ conditions and the general population. On the other
hand, condition-specifi c instruments are often more focused on a particular disease
or health condition (e.g., rheumatoid arthritis or spondyloarthritis), a patient popula-
tion (e.g., older adults), a specifi c problem or symptom (e.g., pain or fatigue), or a
described function (e.g., activities of daily living) [ 64 ]. Disease-specifi c tools tend
to be multidimensional [ 65 ] (Table 4.1 ) [ 12 , 13 , 18 , 62 , 63 , 66 – 69 ].
For any given area of health, condition-specifi c instruments may have greater
clinical appeal due to incorporation of content specifi c to the particular conditions,
and the likelihood of increased responsiveness to interventions. In view of the fact
that there is no single measure that can serve as a gold standard in all patients suf-
4 PROMs for Rheumatoid Arthritis