Background We have seen remarkable achievements in disease control (DAS28) in rheumatoid arthritis in the past decade. They were, however, not accompanied to the same degree by improvements in patient reported outcomes.
Objectives To evaluate whether the relationship between patient global health and physician assessment of disease activity, both measured on numerical rating scales 0-10, has changed in the last decade and if these changes differ between diagnoses or depend on sex, age or disease duration.
Methods Patients recorded in the National Database of the German Collaborative Arthritis Centres between 2000 and 2012 for whom both physician and patient assessments were available were evaluated. The percentages of patients assessing their global health worse than the physician rating of disease activity were analysed for the diagnoses rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriasis arthritis (PsA), systemic lupus erythematodes (SLE) and polymyalgia rheumatica (PMR) with regard to sex, age and disease duration.
Results In 2000, patient ratings were on average 0.9-1.6 scores worse than physician ratings. These differences further increased by 0.4-1.2 scores until 2012. When comparing diagnoses in 2000, patient ratings at least one score worse than physician ratings were found in 62-65% of patients with RA, AS, PsA and PMR, and in 53% of patients with SLE. We saw an increase of poorer patient ratings by 12-16% for all diagnoses but AS (7%) between 2000 and 2012. Except for AS, male patients showed a stronger increase in discrepant ratings over time. Patients aged up to 40 had a higher agreement between physicians and patients than older patients. Poorer patient ratings were more frequent in patients with longer disease duration. The higher rates with both increasing age and disease duration are probably also reflecting the burden of co-morbid conditions. Changes of these rates between 2000 and 2012 seem not to depend on age or disease duration.
Conclusions The discrepancies between patient and physician ratings have increased over the past decade for different diagnoses. In addition to a rising importance of quality of life in public perception in recent years, in times of almost universal internet access this might also reflect the better informed patient with higher expectations. This should be taken into account when comparing patient reported outcomes over long periods.
Disclosure of Interest : D. Huscher Grant/research support: The database was funded by the German Federal Minister of Research from 1999 to 2007 (grant #01 GI 0344/3). Since 2007, the Working Group of the regional corporate arthritis centers and a consortium of pharmaceutical companies has been funding the National Database by an unconditional grant to the German Rheumatological Society., K. Albrecht: None declared, S. Bischoff: None declared, K. Thiele: None declared, A. Krause: None declared, S. Späthling-Mestekemper: None declared, S. Wassenberg: None declared, A. Zink: None declared