Why not use OSRA? A comparison of Overall Status in Rheumatoid Arthritis (RA) with ACR core set and other indices of disease activity in RA

Abstract

Objective: The Overall Status in Rheumatoid Arthritis (OSRA) is a recently validated measure designed for routine immediate clinical use in patients with rheumatoid arthritis (RA). It is composed of demographic data, activity score (activity total), damage score (damage total), and drug treatment. We tested the hypothesis that this tool relates to existing measures and pooled indices of disease activity, including the SF-36.

Methods: Demographic information, OSRA, SF-36, and the ACR core set [inflammatory indicators (ESR, CRP), tender and swollen joints, visual analog scale for pain, Patient and Physician Global Assessment, and Health Assessment Questionnaire (HAQ)] were collected for 86 consecutive outpatients with RA who were starting or changing second-line therapy and again at 6 months. OSRA measures were examined for their relationship to all core set variables (SF-36, HAQ, Stoke Index, Disease Activity Score, and Mallya-Mace) using Spearman's rank correlation. OSRA was used to audit 246 consecutive outpatients with RA to determine its clinical utility.

Results: The median age was 58 years (range 29-82); median disease duration 63 mo (range 3-384); OSRA disease activity (mean 3.8, range 0-8) and damage (mean 2.7, range 0-7) scores were strongly associated with specific ACR core set and SF-36 measures, and all pooled indices examined. OSRA disease activity was significantly higher in outpatients in whom second-line therapy was changed.

Conclusion: (1) The OSRA was highly correlated with HAQ and core set measures of disease activity: (2) the OSRA damage total was strongly associated with HAQ and correlated strongly with both duration and Larsen score; (3) OSRA scores also correlated well with specific SF-36 measures (activity total with Physical Functioning and Bodily Pain; damage total with Physical and Social Functioning); (4) OSRA shows good correlation with pooled indices that cannot be performed immediately in clinic; and (5) the OSRA activity score shows a strong association with clinical decisions made in the outpatient department.