Background The physician's assessment of disease activity has been shown to be a determinant factor for therapeutic interventions in Rheumatoid Arthritis. The adequacy of this assessment is, therefore, crucial to assure that the best options are taken in the perspective of the patient's interest.
Objectives With this study we aim to evaluate the determinants of Physicians' Global Assessment of Disease Activity.
Methods Consecutive RA patients followed in a Tertiary Rheumatology Department were included in this cross-sectional study. Patient demographics and clinical assessments were collected through a standardized protocol which includes age, gender, disease duration, DAS284v-PCR (and its individuals measures), Hospital Anxiety and Depression Scale (HADS), Happiness Scale (HS), Health Assessment Questionnaire (HAQ), Pain (VAS 0-100mm), Fatigue (VAS 0-100mm), Mobility and deformity in the physicians perspective (VAS 0-100mm), Sleep, Physical and emotional wellbeing in the patients' perspective, using RAID questions. The Physician's Global Assessment of Disease Activity (PhGA-VAS 0-100 mm) was registered at the same time. Correlations between PhGA and other variables were evaluated through Pearson's Correlation Coefficient. Variables identified as correlated in the univariate analysis (p<0,05) were included in linear regression stepwise model to identify independent predictors of PhGA. p<0,05 was considered statistical significant in all statistical analysis.
Results 101 RA patients (82% females, mean disease duration of 13,0±8,6 years, mean age of 58,8±12,4 years old) were included. PhGA was strongly associated only with swollen joint 44 (r=0,826, p<0,001) and 28 count (r=0,812, p<0,001). Moderate correlation was observed with ESR (r=0,355, p<0,001) and Pain-VAS (r=0,326, p=0,001). PhGA showed a weak correlation with 44 tender joint count (r=0,287, p<0,05), Physicians' assessment of patient deformity (r=0,207, p=0,04) and function (r=0,213, p<0,036). No correlation was found with the most other important outcomes as sleep, fatigue, wellbeing or psychological aspects. In the multivariate analysis, swollen joint count (in 44) was the most important predictor of PhGA-VAS (β=4,620, 95%CI:3,96;5,28], p<0,001). Other significant predictors were ESR ((β=0,176, 95%CI: [0,07;0,281], p<0,002) and Patient Pain-VAS (β=0,07; 95%CI:[0,1;0,31], p<0,002). This model explains around 77% of the PhGA (R2:0,777; p<0,001).
Conclusions Physicians consider mainly objective measures when assessing disease activity, apparently disregarding the patient's perspective. Although this is in line with current treat-to-target strategies, it may lead to sub-optimal management approaches in the perspective of diminishing the overall impact of the disease in the patient's life.
Disclosure of Interest None declared