Background Disagreement on disease activity between rheumatoid arthritis (RA) patients and rheumatologists may influence treatment decisions and compliance.
Objectives To compare -and identify determinants of- the assessment of disease activity on a visual analogue scale (VAS, 0=best possible, 100=worst possible) by patients (VAS-pt) and physicians (VAS-phy), and to investigate if they are influenced by time.
Methods Anonymous data were used from 2118 Dutch patients included in the METEOR database, a worldwide online tool for disease monitoring in RA. Intra-class correlation coefficients (ICC) were calculated as a measure of agreement and a Bland Altman plot was created to visualize the differences between VAS-pt and VAS-phy. Linear Mixed Model analysis was used to model the VAS-pt and VAS-phy over time. Gender, age, HAQ, swollen joint count, tender joint count, VAS pain, disease duration and BSE were considered as possible determinants of the VAS-pt or VAS-phy.
Results Mean age was 57 years (SD: 15) and 67% of the patients were female. Correlation between VAS-pt and VAS-phy was moderate (ICC 0.61; p<0.01).
Patients score on average 11 points higher (worse) than rheumatologists at the first registered visit (95% limits of agreement: -25.2 to 47.6). Scores were increasingly discordant towards the higher end of the scale. Both VAS-phy and VAS pt increase by the tender joint count, HAQ-score and patient’s VAS for pain. VAS-phy, but not VAS-pt, also increases by swollen joint count. VAS-phy decreases by disease duration, and VAS-pt showed a similar trend.
Conclusions Patients score VAS disease activity systematically higher than rheumatologists, although patients’ and physicians’ VAS are more or less associated with the same determinants: HAQ-score, tender joint count and VAS pain. But physicians put more weight on swollen joint count, and score lower disease activity over time, whilst patients do not.
Disclosure of Interest None Declared