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to target. Results revealed that the crude functional disability score as well as the
percentage changes at 3 and 6 months showed a signifi cant increase in the group
with persistent infl ammatory synovitis compared to the self-limiting arthritis group.
Using binary logistic regression analyses to assess the association between func-
tional disability and disease activity fl are up revealed that a fl are was associated
with poor baseline function and quality of life measures: functional disability (OR
per 0.1 unit = 1.8 [1.06–1.54], p = 0.004) and quality of life (OR = 1.12 [1.01–1.23],
p = 0.024). Patient global assessment and pain score were associated signifi cantly
with scores of DAS-28, ACR response, systemic manifestations, and work ability.
Changes in the functional disability scores correlated signifi cantly to changes in PD
scores ( p < 0.01). In multiple conditional logistic regression analysis, factors associ-
ated with the development of joint space narrowing were worsening of functional
disability score by > 0.5/3, synovial thickening and synovial PD score ≥ 2 at both
baseline and 6 months of treatment. The discriminative power had an AUC of 0.864
(95 % CI 0.765–0.937), with sensitivity 84 %, specifi city 92 %, and likelihood
ratio + 5.6. Another study [ 39 ] assessed the use of PROMs to assess for comorbidity.
Results revealed that PROMs questionnaire were able to identify patients at high
cardiovascular risk, high falls as well as infection risk. In view of these data, PROMs
met the criteria of a valid marker for rheumatoid arthritis, being objectively mea-
sured, indicator of normal and pathologic joint affection, as well as a sensitive and
specifi c marker for response to therapy and poor prognosis.
Embedding Patient-Reported Outcome Measures
in the Decision-Making Process
The expansion in use of economic evaluation by health agencies has mirrored the
growing recognition of the usefulness of health-related quality of life as an important
indicator of outcome of disease treatment among clinicians and patients [ 33 , 79 , 80 ].
Pati ent-reported experience measures (PREMs) became an independent assessment
tool to measure management outcomes [ 81 ]. A cornerstone of such analysis is the
quality-adjusted life year (QALY), which is formed by the arithmetic product of
quantity and quality of life. Such economic implication raised the issue of shared
decision-making between the patient and the treating physician as the recommended
approach in clinical practice. Shared decision-making is a process in which patients
are encouraged to participate in selecting appropriate treatments or management
options. The constituent elements of QALY are: health-related quality of life mea-
sures and survival. In the UK, the mechanics for collecting patient-based HRQOL
assessments have been presaged in the National Health Service from 2009, requiring
both pre- and post-surgery PROMs assessment of health status in selected proce-
dures [ 82 ]. Embedding such data within national health information systems would
facilitate an easier interpretation of QALY-based information. Furthermore, assimi-
lating health-related quality of life into routine clinical rheumatology practice will
assist not only the quality of care provided but also the longer-term development of
Y. El Miedany