Background Patient global assessment (PGA) in patients with rheumatoid arthritis (RA) often does not meet evaluator global assessment (EGA). It is reported that PGA is not influenced only by the disease activity of RA.
Objectives We evaluated correlation of PGA and EGA for psychological state and health status in patients with RA.
Methods The patients with RA (n=112) were recruited. Disease activity was evaluated with swollen joint counts (SJC), tender joint counts (TJC) and Clinical Disease Activity Index (CDAI), and PGA and EGA were assessed with visual analog scale (VAS). Depression and anxiety were examined utilizing the Hospital Anxiety and Depression Scale-Depression (HADS-D) and the State-Trait Anxiety Inventory (STAI), respectively. General health status was evaluated with Sort Form-36 (SF-36). Comparison analyses were performed between remission group (VAS≤1cm) and non-remission group (VAS>1cm) in PGA and EGA. Data analyses were performed utilizing Wilcoxon rank-sum test and Spearman correlation analysis.
Results There was no significant difference in age, disease duration and PSL dosage between PGA remission group (n=35) and non-remission group (n=77) or EGA remission group (n=38) and non-remission group (n=74). In clinical evaluation, SJC, TJC and CDAI were significantly lower in remission groups of PGA and EGA compared to non-remission (p<0.0001, p<0.0001 and p<0.0001, respectively). There was good relation of EGA to both SJC and TJC (r=0.7725 and r=0.6758, p<0.0001 and p<0.0001, respectively), and that's degree of association was stronger than PGA (r=0.4365 and r=0.5060, <0.0001 and p<0.0001, respectively). Concerning depression and anxiety, STAI (State) was significantly lower in remission group compared to non-remission in PGA (p<0.05), while no significant difference in EGA (p=0.2463). Similarly in HADS-D, the number of patients with depression was significantly fewer in PGA remission group (p<0.05), while no significant difference in EGA (p=0.2522). In SF-36, all of eight components were better significantly in PGA remission group, while there was no significant difference in mental health between two groups in EGA (p=0.1602).
These results indicate that EGA was related to disease activity of RA assessed with SJC and TJC stronger than PGA and there was no significant difference in anxiety, depression and mental health of SF-36 between EGA remission group and non-remission group. On the other hand, PGA non-remission group had depression or anxiety more than PGA remission group. Moreover, mental health of SF-36 was also significantly worse in non-remission group in PGA.
Conclusions Discrepancy between PGA and EGA may be partially explained by the difference in psychological state or health status. Support for psychological state may be effective for improvement of PGA, resulting in real remission.
Disclosure of Interest : None declared