Ab0222 pictorial representation of illness and self-measure (prism): a visual tool to assess the burden of rheumatoid arthritis

Background Rheumatoid arthritis (RA) has a negative impact on patients’ quality of life, with both physical and psychosocial impact. Treatment recommendations advocate a treat-to-target (T2T) approach with the ideal goal of remission. Composite clinimetric scores are available to assess and monitor disease activity; however, although now widely recognized as an important aspect, the patients’ perceived burden of disease still remains not regularly checked during medical consultation in daily practice. Pictorial Representation of Illness and Self Measure (PRISM) was developed to measure this global suffering but, to our knowledge, not yet used in RA patients. Objectives To understand the relationships and correspondences between common clinimetric indexes and patients’ perception of RA impact on daily life measured by PRISM. Methods The present single-center explorative study included 86 RA patients, consecutively evaluated between July and December 2022 at our Rheumatoid Arthritis Clinic. During routinely scheduled follow up visits, disease activity, organ damage, treatment changes, and a number of clinimetric indices were regularly recorded. Patients were also asked to complete the basic PRISM. The physician showed patients a blank sheet with a yellow circle in a corner and they were asked to imagine the sheet as their “life” at the moment, while the yellow circle as “themselves”. Next, patients were asked to imagine another smaller as RA and were asked the question: “Where would you place the RA-red circle in your life now?”. The distance between both circles (SIS) reflects the patient’s burden of suffering. A higher SIS indicates a lower burden. A blue circle has been used as an example before testing. Statistical tests produced regression R2 values and Pearson correlation coefficients. Results PRISM proved to correlate very well particularly with the Rheumatoid Arthritis Impact of Disease (RAID) score (p = -0,6), patient’s global assessment (PtGA) (p = -0,59), patient’s pain (p = -0,52) and global health (p = -0,52) but no correlation was observed with swollen joint count or tender joint count. PRISM also correlates to composite clinimetric indexes exploring disease activity but to a lesser extent, while it revealed no correlation with inflammatory indexes such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Conclusion Our investigation showed significant correlation with subjective patient reported outcome (PRO) tool, not counting inflammatory indexes nor joint count. To a lesser extent, it correlates also with physician’s global assessment (PhGA). PRISM strongly correlates with RAID questionnaire, which is one of the most valid tool to measure the impact of RA in different domains (pain, function, fatigue, sleep disturbance, emotional well-being, physical well-being and coping). PRISM may therefore represent a reliable new, easy, more intuitive and friendly approach to quantify each individual perceived burden of disease. It may serve as complementary to common disease activity measures in setting agreed personalized therapeutic targets. Patients who were asked for a degree of approval with the test showed satisfaction with the possibility of visually showing the degree of suffering caused by their disease. To the best of our knowledge, this is the larger cohort of RA patients described in literature tested with PRISM. A prospective validation study in RA is now ongoing. Reference [1] Peter N, Kleinjung T, Horat L, Schmidt-Weitmann S, Meyer M, Büchi S, Weidt S. Validation of PRISM (Pictorial Representation of Illness and Self Measure) as a novel visual assessment tool for the burden of suffering in tinnitus patients. Health Qual Life Outcomes. 2016 Mar 22;14:47. doi: 10.1186/s12955-016-0454-2. Figure 1. Acknowledgements: NIL. Disclosure of Interests None Declared.