Background The Rheumatoid Arthritis Disease-Modifying Anti-Rheumatic Drug Intervention and Utilization Study 1 (RADIUS 1) is a 5-year observational registry that assessed use, efficacy, and safety of disease-modifying antirheumatic drugs (DMARDs) in patients with rheumatoid arthritis (RA). Post hoc analyses showed a disconnect between global assessments made by physicians (PhGA) and patients (PtGA) across many RA treatments.1
Objectives We sought to retrospectively analyze the RADIUS 1 cohort dataset for specific factors that may have influenced the discordance in PhGA and PtGA.
Methods The RADIUS 1 cohort (N=4968) consisted of primarily community-based private practice patients (88%) with RA requiring either the addition of or a switch to a new biologic or nonbiologic DMARD. Periodic assessments included PhGA, PtGA, Health Assessment Questionnaire–Disability Index (HAQ-DI), tender/painful joint count (TJC28), swollen joint count (SJC28), pain Visual Analog Scale (VAS), and acute-phase reactants. Spearman rank correlations and associated 95% CIs (using a Fisher transformation) were calculated between PhGA and PtGA, and a Forest plot of the overall correlation data was generated.
Results A total of 4359 patients who required either addition of or switch to a new DMARD were included in the analysis and had a mean disease duration of 7.3 years (SD=9.1). As shown in the Forest plot (Figure), PhGA correlated most highly with TJC28 (0.6956, 95% CI 0.6881–0.7030) and SJC28 (0.6757, 95% CI 0.6678–0.6834), whereas only moderate overall correlations were observed with PtGA for these factors (0.5000; 95% CI, 0.4890–0.5108 and 0.3754; 95% CI, 0.3628–0.3878, respectively). PtGA most strongly correlated with pain VAS (0.8349; 95% CI, 0.8305–0.8392) and moderately correlated with HAQ-DI (0.5979; 95% CI, 0.5886–0.6071). The corresponding values for PhGA were 0.5835 (95% CI 0.5739–0.5928) for pain VAS and 0.4694 (95% CI, 0.4581–0.4805) for HAQ-DI. Acute-phase reactants poorly correlated with PhGA and PtGA (data not shown).
Conclusions PhGA had higher correlations with joint counts than PtGA, while PtGA had higher correlations with pain VAS and HAQ-DI than PhGA, suggesting that physicians rely heavily on the physical exam to make global assessments and patients view disease activity more in terms of pain and disability. Physicians may gain better insight into the patient’s perception of disease impact by increased awareness of HAQ, pain VAS, and PtGA, thus adding context to joint counts.
Study sponsored by Amgen and Pfizer.
Weaver et al. Ann Rheum Dis 2011;70:724.
Disclosure of Interest J. Markenson Consultant for: Amgen Inc, A. Koenig Employee of: Pfizer Inc, J.-Y. Feng Employee of: Amgen Inc, S. Chaudhari Consultant for: Amgen Inc, D. Zack Employee of: Amgen Inc, D. Collier Employee of: Amgen Inc, A. Weaver Consultant for: Amgen Inc
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