RESEARCH - Dating the window of therapeutic opportunity in early RA: accuracy of patient recall of arthritis symptom onset

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J Rheumatol. 2004 Sep;31(9):1686-92.

Dating the " window of therapeutic opportunity " in early rheumatoid

arthritis: accuracy of patient recall of arthritis symptom onset.

Amjadi-Begvand S, Khanna D, Park GS, Bulpitt KJ, Wong WK, us HE.

Division of Rheumatology, UCLA School of Medicine, Los Angeles,

California; and Department of Biostatistics, UCLA School of Public

Health.

OBJECTIVE: A " window of therapeutic opportunity " has been hypothesized

to be present in early rheumatoid arthritis (RA). To determine the date

of this window, we must know the symptom-onset date of the RA. Patients

participating in an observational study of early aggressive rheumatoid

factor (RF) positive RA were evaluated to assess the accuracy of their

recall of symptom-onset date by comparing the onset date they reported

at the first visit with that reported on subsequent 6-monthly

questionnaires. METHODS: One hundred eighty-six patients with early RA

(at entry: median disease duration 5.8 mo, mean RF 413.8 +/- 630.7

IU/ml, 20.6 +/- 10.9 swollen and 23.7 +/- 13.4 tender joints) completed

a self-reported mailed questionnaire every 6 months for up to 5 years.

As a part of each questionnaire, patients were asked to recall their RA

symptom-onset date. These dates were then compared to the dates reported

on the initial questionnaire. RESULTS: Thirteen months after symptom

onset (i.e., about 6 mo after study entry) 61% of patients recalled the

symptom-onset date (within 1 mo) that they had reported at baseline; the

proportion decreased to 39% at 31 months and 25% after 70 months. During

this period, the proportion overestimating RA duration remained about

20%, but the proportion underestimating it increased from 23% at 13

months to 39% at 31 months, and to 50% after 56 months. Patients with

longer disease duration, less disease activity, and higher pain levels

tended to be less accurate.

CONCLUSION: Accuracy of recall of RA symptom-onset date by patients

tends to decline over a period of 5 years. This should be taken into

consideration when enrolling patients, when interpreting the findings of

early RA clinical trials, and when attempting to ascertain the presence

of a window of therapeutic opportunity.

PMID: 15338485

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

5338485 & dopt=Abstract

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