Background A physician estimate of a patient's global status (DOCGL) often is the most efficient of all 7 core data set measures to distinguish active from control treatments in clinical trials1. DOCGL is designated to assess inflammatory activity. However, DOCGL may be influenced by damage and chronic pain syndromes. Therefore, 3 new physician global (0-10) visual analog subscales (VAS) have been developed to assess subsets of physician estimates for (a) inflammation, (b) damage, and (c) “neither” (usually fibromyalgia/somatization).
Objectives To analyze physician subscales for inflammation, damage and “neither” in patients with 4 rheumatic diseases, RA, OA, SLE, and FM, and to compute correlations of overall DOCGL with the 3 physician subscales and with patient global estimate (PATGL) in these 4 diagnosis groups.
Methods All patients seen in routine care at one academic clinical setting by eight rheumatologists are assigned 4 global estimates ranging from 0 (none) to 10 (highest) VAS, including overall DOCGL, physician scores for inflammation, damage to any organ (e.g., joint, kidney), and “neither”. A cross-sectional analysis was performed of a random visit between September and December 2014 of consecutive patients with 4 primary diagnoses: RA (n=108), OA (n=131), SLE (n=73), and FM (n=51). Results are presented as median and interquartile range (IQR) of non-normally distributed data. Spearman correlations were calculated to estimate associations of the overall DOCGL with subscales and PATGL in the 4 diagnosis groups.
Results Median DOCGL ranged from 3 to 5, highest for patients with FM (5.0), followed by OA (4), RA (3.5), and SLE (3). The highest median score for inflammation was for patients with RA (1.5), for damage in patients with OA (4.2) and for “neither” in patients with FM (5.2) (Table). The highest correlation with DOCGL was seen for the inflammation subscale in RA, damage in OA, and “neither” in FM. In patients with SLE, correlations of three subscales with DOCGL were similar. DOCGL was correlated significantly with PATGL in RA, SLE, and OA, but not in FM.
Conclusions Physician estimates for inflammation, damage, and “neither” differ according to different rheumatic diagnoses. These 3 subscales supplement the overall physician global estimate as a quantitative summary of the history and physical examination, to assess and monitor patients with rheumatic diseases in usual care.
Pincus T, Richardson B, Strand V, Bergman MJ. Relative efficiencies of the 7 rheumatoid arthritis Core Data Set measures to distinguish active from control treatments in 9 comparisons from clinical trials of 5 agents. Clin Exp Rheumatol. 2014;32 Suppl 85(5):47-54.
Disclosure of Interest None declared