Background About one third of physician global estimates (DOCGL) of rheumatoid arthritis (RA) disease activity are >20mm lower than patient global estimates (PATGL) on a 100 mm visual analog scale (VAS). Some studies indicate that DOCGL is more likely to be lower than PATGL in female patients, suggesting underestimation of severity, even after adjusting for clinical measures of disease activity. Studies in other clinical areas suggest that physician and patient gender affect their interaction. Little information is available concerning possible discordance in global estimates of RA activity between male and female rheumatologists in male and female patients.
Objectives To study potential discordance in DOCGL and PATGL according to gender of both rheumatologists and RA patients in the Danish nationwide DANBIO-registry.
Methods Physician gender was requested as part of a questionnaire sent to DANBIO physicians (n = 265). PATGL and DOCGL global scores and patient gender were obtained from DANBIO first encounter between the physicians and their patients. Consistent with the literature, a difference between DOCGL and PATGL of up to 20 mm was considered concordant. Statistical analyses of the differences between the four possible physician-patient gender groups and discordance were performed using chi-square test.
Results The 90 physicians who returned the questionnaire (34%) were matched with first encounters of a total of 8,970 patients. The physicians were 55% female, with median age 52 years for female physicians and 53 years for male physicians. Patients were 74% females. Overall, 50% of the encounters were concordant, 48% were negative discordant and 2% were positive discordant.
Conclusions This study in routine care indicates more negative discordance between patient and physician in female patients, with even greater disagreement if the physician is female.
Khan NA et al. Determinants of discordance in patients´ and physicians´ rating of rheumatoid arthritis disease activity. Arthritis Care Res (Hoboken) 2012;64:206-14.
Disclosure of Interest C. Lindström Egholm: None Declared, T. Pincus: None Declared, L. Dreyer: None Declared, T. Ellingsen: None Declared, B. Glintborg: None Declared, M. Kowalski Consultant for: Abbott (AbbVie), T. Lorenzen Consultant for: Roche, Pfizer and Bristol Myers Squibb, O. Madsen: None Declared, C. Rasmussen: None Declared, H. Nordin: None Declared, M. Hetland: None Declared