Identifying flares in rheumatoid arthritis

Reliability and construct validation of the OMERACT RA Flare Core Domain Set

on behalf of the OMERACT RA Flare Group, CATCH Investigators

Research output: Contribution to journalArticle

Abstract

Objective: To evaluate the reliability of concurrent flare identification using 3 methods (patient, rheumatologist and Disease Activity Score (DAS)28 criteria), and construct validity of candidate items representing the Outcome Measures in Rheumatology Clinical Trials (OMERACT) RA Flare Core Domain Set. Methods: Candidate flare questions and legacy measures were administered at consecutive visits to Canadian Early Arthritis Cohort (CATCH) patients between November 2011 and November 2014. The American College of Rheumatology (ACR) core set indicators were recorded. Concordance to identify flares was assessed using the agreement coefficient. Construct validity of flare questions was examined: convergent (Spearman's r); discriminant (mean differences between flaring/non-flaring patients); and consequential (proportions with prior treatment reductions and intended therapeutic change postflare). Results: The 849 patients were 75% female, 81% white, 42% were in remission/low disease activity (R/LDA), and 16-32% were flaring at the second visit. Agreement of flare status was low-strong (κ's 0.17-0.88) and inversely related to RA disease activity level. Flare domains correlated highly (r's≥0.70) with each other, patient global (r's≥0.66) and corresponding measures (r's 0.49-0.92); and moderately highly with MD and patient-reported joint counts (r's 0.29-0.62). When MD/patients agreed the patient was flaring, mean flare domain between-group differences were 2.1-3.0; 36% had treatment reductions prior to flare, with escalation planned in 61%. Conclusions: Flares are common in rheumatoid arthritis (RA) and are often preceded by treatment reductions. Patient/MD/DAS agreement of flare status is highest in patients worsening from R/LDA. OMERACT RA flare questions can discriminate between patients with/without flare and have strong evidence of construct and consequential validity. Ongoing work will identify optimal scoring and cut points to identify RA flares.

Original languageEnglish (US)
Article numbere000225
JournalRMD Open
Volume2
Issue number1
DOIs
StatePublished - 2016

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Rheumatology
Rheumatoid Arthritis
Outcome Assessment (Health Care)
Clinical Trials
Therapeutics
Arthritis
Joints

ASJC Scopus subject areas

  • Rheumatology
  • Immunology
  • Immunology and Allergy

Cite this

Identifying flares in rheumatoid arthritis : Reliability and construct validation of the OMERACT RA Flare Core Domain Set. / on behalf of the OMERACT RA Flare Group; CATCH Investigators.

In: RMD Open, Vol. 2, No. 1, e000225, 2016.

Research output: Contribution to journalArticle

on behalf of the OMERACT RA Flare Group ; CATCH Investigators. / Identifying flares in rheumatoid arthritis : Reliability and construct validation of the OMERACT RA Flare Core Domain Set. In: RMD Open. 2016 ; Vol. 2, No. 1.
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title = "Identifying flares in rheumatoid arthritis: Reliability and construct validation of the OMERACT RA Flare Core Domain Set",
abstract = "Objective: To evaluate the reliability of concurrent flare identification using 3 methods (patient, rheumatologist and Disease Activity Score (DAS)28 criteria), and construct validity of candidate items representing the Outcome Measures in Rheumatology Clinical Trials (OMERACT) RA Flare Core Domain Set. Methods: Candidate flare questions and legacy measures were administered at consecutive visits to Canadian Early Arthritis Cohort (CATCH) patients between November 2011 and November 2014. The American College of Rheumatology (ACR) core set indicators were recorded. Concordance to identify flares was assessed using the agreement coefficient. Construct validity of flare questions was examined: convergent (Spearman's r); discriminant (mean differences between flaring/non-flaring patients); and consequential (proportions with prior treatment reductions and intended therapeutic change postflare). Results: The 849 patients were 75{\%} female, 81{\%} white, 42{\%} were in remission/low disease activity (R/LDA), and 16-32{\%} were flaring at the second visit. Agreement of flare status was low-strong (κ's 0.17-0.88) and inversely related to RA disease activity level. Flare domains correlated highly (r's≥0.70) with each other, patient global (r's≥0.66) and corresponding measures (r's 0.49-0.92); and moderately highly with MD and patient-reported joint counts (r's 0.29-0.62). When MD/patients agreed the patient was flaring, mean flare domain between-group differences were 2.1-3.0; 36{\%} had treatment reductions prior to flare, with escalation planned in 61{\%}. Conclusions: Flares are common in rheumatoid arthritis (RA) and are often preceded by treatment reductions. Patient/MD/DAS agreement of flare status is highest in patients worsening from R/LDA. OMERACT RA flare questions can discriminate between patients with/without flare and have strong evidence of construct and consequential validity. Ongoing work will identify optimal scoring and cut points to identify RA flares.",
author = "{on behalf of the OMERACT RA Flare Group} and {CATCH Investigators} and Bykerk, {Vivian P.} and Clifton Bingham and Choy, {Ernest H.} and Daming Lin and Rieke Alten and Robin Christensen and Furst, {Daniel E.} and Sarah Hewlett and Amye Leong and Lyn March and Thasia Woodworth and Gilles Boire and Boulos Haraoui and Carol Hitchon and Shahin Jamal and Keystone, {Edward C.} and Janet Pope and Diane Tin and Thorne, {J. Carter} and Bartlett, {Susan J.} and Annelies Boonen and {Den Broeder}, Alfons and Bruno Fautrel and Francis Guillemin and Anne Lyddiatt and May, {James E.} and Pam Montie and Ana-Maria Orbai and Christoph Pohl and Voshaar, {Marieke Scholte} and Vandana Ahluwalia and Pooneh Akhavan and Murray Baron and William Bensen and Louis Bessette and Ines Colmegna and Alice Kinkhoff and Majed Kraishi and Maggie Larche and Chris Lyddell and Bindu Nair and Chris Penney and Laurence Rubin and Carter Thorne and Michel Zummer",
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T2 - Reliability and construct validation of the OMERACT RA Flare Core Domain Set

AU - on behalf of the OMERACT RA Flare Group

AU - CATCH Investigators

AU - Bykerk, Vivian P.

AU - Bingham, Clifton

AU - Choy, Ernest H.

AU - Lin, Daming

AU - Alten, Rieke

AU - Christensen, Robin

AU - Furst, Daniel E.

AU - Hewlett, Sarah

AU - Leong, Amye

AU - March, Lyn

AU - Woodworth, Thasia

AU - Boire, Gilles

AU - Haraoui, Boulos

AU - Hitchon, Carol

AU - Jamal, Shahin

AU - Keystone, Edward C.

AU - Pope, Janet

AU - Tin, Diane

AU - Thorne, J. Carter

AU - Bartlett, Susan J.

AU - Boonen, Annelies

AU - Den Broeder, Alfons

AU - Fautrel, Bruno

AU - Guillemin, Francis

AU - Lyddiatt, Anne

AU - May, James E.

AU - Montie, Pam

AU - Orbai, Ana-Maria

AU - Pohl, Christoph

AU - Voshaar, Marieke Scholte

AU - Ahluwalia, Vandana

AU - Akhavan, Pooneh

AU - Baron, Murray

AU - Bensen, William

AU - Bessette, Louis

AU - Colmegna, Ines

AU - Kinkhoff, Alice

AU - Kraishi, Majed

AU - Larche, Maggie

AU - Lyddell, Chris

AU - Nair, Bindu

AU - Penney, Chris

AU - Rubin, Laurence

AU - Thorne, Carter

AU - Zummer, Michel

PY - 2016

Y1 - 2016

N2 - Objective: To evaluate the reliability of concurrent flare identification using 3 methods (patient, rheumatologist and Disease Activity Score (DAS)28 criteria), and construct validity of candidate items representing the Outcome Measures in Rheumatology Clinical Trials (OMERACT) RA Flare Core Domain Set. Methods: Candidate flare questions and legacy measures were administered at consecutive visits to Canadian Early Arthritis Cohort (CATCH) patients between November 2011 and November 2014. The American College of Rheumatology (ACR) core set indicators were recorded. Concordance to identify flares was assessed using the agreement coefficient. Construct validity of flare questions was examined: convergent (Spearman's r); discriminant (mean differences between flaring/non-flaring patients); and consequential (proportions with prior treatment reductions and intended therapeutic change postflare). Results: The 849 patients were 75% female, 81% white, 42% were in remission/low disease activity (R/LDA), and 16-32% were flaring at the second visit. Agreement of flare status was low-strong (κ's 0.17-0.88) and inversely related to RA disease activity level. Flare domains correlated highly (r's≥0.70) with each other, patient global (r's≥0.66) and corresponding measures (r's 0.49-0.92); and moderately highly with MD and patient-reported joint counts (r's 0.29-0.62). When MD/patients agreed the patient was flaring, mean flare domain between-group differences were 2.1-3.0; 36% had treatment reductions prior to flare, with escalation planned in 61%. Conclusions: Flares are common in rheumatoid arthritis (RA) and are often preceded by treatment reductions. Patient/MD/DAS agreement of flare status is highest in patients worsening from R/LDA. OMERACT RA flare questions can discriminate between patients with/without flare and have strong evidence of construct and consequential validity. Ongoing work will identify optimal scoring and cut points to identify RA flares.

AB - Objective: To evaluate the reliability of concurrent flare identification using 3 methods (patient, rheumatologist and Disease Activity Score (DAS)28 criteria), and construct validity of candidate items representing the Outcome Measures in Rheumatology Clinical Trials (OMERACT) RA Flare Core Domain Set. Methods: Candidate flare questions and legacy measures were administered at consecutive visits to Canadian Early Arthritis Cohort (CATCH) patients between November 2011 and November 2014. The American College of Rheumatology (ACR) core set indicators were recorded. Concordance to identify flares was assessed using the agreement coefficient. Construct validity of flare questions was examined: convergent (Spearman's r); discriminant (mean differences between flaring/non-flaring patients); and consequential (proportions with prior treatment reductions and intended therapeutic change postflare). Results: The 849 patients were 75% female, 81% white, 42% were in remission/low disease activity (R/LDA), and 16-32% were flaring at the second visit. Agreement of flare status was low-strong (κ's 0.17-0.88) and inversely related to RA disease activity level. Flare domains correlated highly (r's≥0.70) with each other, patient global (r's≥0.66) and corresponding measures (r's 0.49-0.92); and moderately highly with MD and patient-reported joint counts (r's 0.29-0.62). When MD/patients agreed the patient was flaring, mean flare domain between-group differences were 2.1-3.0; 36% had treatment reductions prior to flare, with escalation planned in 61%. Conclusions: Flares are common in rheumatoid arthritis (RA) and are often preceded by treatment reductions. Patient/MD/DAS agreement of flare status is highest in patients worsening from R/LDA. OMERACT RA flare questions can discriminate between patients with/without flare and have strong evidence of construct and consequential validity. Ongoing work will identify optimal scoring and cut points to identify RA flares.

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