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Determinants of discordance in patients' and physicians' rating of rheumatoid arthritis disease activity
Author(s) -
Khan Nasim A.,
Spencer Horace J.,
Abda Esam,
Aggarwal Amita,
Alten Rieke,
Ancuta Codrina,
Andersone Daina,
Bergman Martin,
CraigMuller Jurgen,
Detert Jacqueline,
Georgescu Lia,
Gossec Laure,
Hamoud Hisham,
Jacobs Johannes W. G.,
Laurindo Ieda Maria Magalhaes,
Majdan Maria,
Naranjo Antonio,
Pandya Sapan,
Pohl Christof,
Schett Georg,
Selim Zahraa I.,
Toloza Sergio,
Yamanaka Hisahi,
Sokka Tuulikki
Publication year - 2012
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.20685
Subject(s) - erythrocyte sedimentation rate , medicine , rheumatoid arthritis , rating scale , physical therapy , visual analogue scale , odds ratio , morning stiffness , morning , psychology , developmental psychology , psoriatic arthritis
Objective To assess the determinants of patients' (PTGL) and physicians' (MDGL) global assessment of rheumatoid arthritis (RA) activity and factors associated with discordance among them. Methods A total of 7,028 patients in the Quantitative Standard Monitoring of Patients with RA study had PTGL and MDGL assessed at the same clinic visit on a 0–10‐cm visual analog scale (VAS). Three patient groups were defined: concordant rating group (PTGL and MDGL within ±2 cm), higher patient rating group (PTGL exceeding MDGL by >2 cm), and lower patient rating group (PTGL less than MDGL by >2 cm). Multivariable regression analysis was used to identify determinants of PTGL and MDGL and their discordance. Results The mean ± SD VAS scores for PTGL and MDGL were 4.01 ± 2.70 and 2.91 ± 2.37, respectively. Pain was overwhelmingly the single most important determinant of PTGL, followed by fatigue. In contrast, MDGL was most influenced by swollen joint count (SJC), followed by erythrocyte sedimentation rate (ESR) and tender joint count (TJC). A total of 4,454 (63.4%), 2,106 (30%), and 468 (6.6%) patients were in the concordant, higher, and lower patient rating groups, respectively. Odds of higher patient rating increased with higher pain, fatigue, psychological distress, age, and morning stiffness, and decreased with higher SJC, TJC, and ESR. Lower patient rating odds increased with higher SJC, TJC, and ESR, and decreased with lower fatigue levels. Conclusion Nearly 36% of patients had discordance in RA activity assessment from their physicians. Sensitivity to the “disease experience” of patients, particularly pain and fatigue, is warranted for effective care of RA.