Rheumatoid arthritis patients need periodic appointments to track their condition’s progression and adjust their medication as necessary. However, since the majority of patients are in remission at the time of follow-up, it should be able to cut back on their consultations. Electronic patient-reported outcomes (ePROs) might help identify patients who have achieved their treatment objective and are, therefore, qualified to forgo a visit. For a study, researchers sought to determine whether patients with low disease activity scores on their ePROs won’t require a disease-modifying antirheumatic drug (DMARD) or steroid intensification in the first two weeks following the completion of the ePROs.

DMARD or steroid intensifications were gathered from Reade’s anonymized electronic medical record, and the findings of ePROs completed during normal treatment were compared with those. The main result was the positive predictive value (PPV) of a low disease activity score on an ePRO for not obtaining a DMARD or steroid intensification within a two-week period. Routine Assessment of Patient Index Data 3 (RAPID3) (score <2), Patient Acceptable Symptom State (PASS) (yes), and the flare question (no) were the three examined ePROs (with respective low disease activity results). The evaluation of whether ePRO combination produced the best PPV for DMARD or steroid intensifications was the study’s secondary goal.

Over 321 documents were finally included from the 400 that were randomly chosen (302 unique patients). The PPV for not receiving a DMARD or steroid intensification within 2 weeks was 99%, 95%, and 83% for a RAPID3 <2, being in PASS, and giving a false positive to the flare question. A RAPID3 <2 and a negative flare question together produced a PPV of 100%; 29% (93/321) of the study’s overall population had this combination.

The RAPID3, PASS, and flare questions can accurately predict which patients won’t be receiving a DMARD or steroid intensification in the upcoming two weeks. The RAPID3 and flare question combination produced the largest percentage of patients who might be able to forgo a visit and the best diagnostic accuracy.

Reference: journals.lww.com/jclinrheum/Fulltext/2022/12000/Probability_of_Medication_Intensifications_in.3.aspx