Background It is important to evaluate disease activity accurately in Rheumatoid Arthritis (RA). Disease activity assessment is necessary for treatment decision and for achieving remission or low disease activity. A patient self-report, patient’s global assessment (PGA), is one of the outcome measures. Though there is often discordance between patients and physicians in their assessment of RA disease activity.
Objectives The aim of this study is to explore the reasons for this discordance.
Methods 385 RA patients at Nagoya University Hospital were enrolled in this study. Patient global assessment (PGA) using visual analog scale, and physician’s/evaluator’s global assessment (EGA) were assessed independently. Painful joint count (PJC) and swollen joint count (SJC) by patients, and tenderness joint count (TJC) and SJC by physicians, were also assessed independently. Serum C-reactive protein (CRP) and Matrix Metalloproteinase-3 (MMP-3) levels, DAS28, SDAI, were collected.
Results Patients were primarily women (82%), age 60.1±14.0 years. The correlation coefficient between PGA and EGA was 0.46. PGA and EGA were categorized into 3 groups, 10mm or less, 11mm to 50mm, 51mm or more. Comparing cases that PGA and EGA were the same category (226 cases) with cases that PGA was in the higher categories than EGA (117 cases), the average of the difference between TJC and PJC were the former 2.22, the latter 4.40, which showed a significant difference. There was significant difference in the average of CRP, the former 0.54mg/dl, the latter 0.31mg/dl, but not in MMP-3, DAS28, or SDAI.
There were 190 cases which CRP, TJC and SJC by physicians are all 1 or less. Of those cases, the group of PGA was 10mm or less (87 cases) and the group of PGA was 11mm or more (103 cases), the average of the PJC was a significant difference in 1.01, 3.88, respectively. The average of CRP was the former 0.13mg/dl, the latter 0.20mg/dl, which also showed a significant difference, but not in MMP-3.
Conclusions About 30% of RA patients assessed their disease activity higher than physicians do. Discordance between PJC and TJC affects the discordance between PGA and EGA.
Disclosure of Interest T. Watanabe: None Declared, T. Kojima Speakers bureau: Mitsubishi Tanabe Pharma Corporation, Takeda Pharma Corporation, Eisai Pharma Corporation, Chugai Pharma Corporation, Abbott, Bristol-Myers, N. Takahashi: None Declared, K. Funahashi: None Declared, D. Kato: None Declared, Y. Hattori: None Declared, M. Hanabayashi: None Declared, K. Terabe: None Declared, Y. Yoshioka: None Declared, N. Ishiguro Speakers bureau: Mitsubishi Tanabe Pharma Corporation, Takeda Pharma, Corporation, Eisai Pharma Corporation, Chugai Pharma Corporation, Abbott, Bristol-Myers Squibb and Pfizer