Background Patient global perception of disease activity is included in the different indices of disease activity in Rheumatoid Arthritis (RA). However, patients and physicians frequently disagree in their assessment of this parameter.
Objectives With this study we aim to evaluate the extent of this discrepancy and explore its determinants.
Methods Consecutive RA patients followed in a Tertiary Rheumatology Department were included in this cross-sectional study. Patient demographics and clinical data were collected through a standardized protocol which includes age, gender, educational level, disease duration, DAS283v (and its individual measures), Hospital Anxiety and Depression Scale (HADS), Happiness Scale (HS), Health Assessment Questionnaire (HAQ), Pain (VAS 0-100 mm),Fatigue (VAS 0-100 mm), Mobility and Deformity in patient perception (0-100mm). Physician (PhGA) and Patient Global Assessment of Disease Activity (PGA) were collected as VAS 0-100 mm at the same time. The discrepancy between Patients and Physicians (ΔGA) was defined as PGA minus PhGA. Correlations between ΔGA and other variables were evaluated through Pearson's Correlation Coefficient. Variables identified as correlated in the univariate analysis (p<0,05) were included in a linear regression stepwise model to identify independent predictors of this discrepancy. For all statistical analysis a p<0,05 was considered statistical significant.
Results 101 RA patients (82% females, mean disease duration 13,0±8,6 years, mean age 58,8±12,41 years old) were included. The mean difference of Disease Activity assessment between patients and physicians was 37,89 (±28,6), with patients generally rating their disease activity higher than their physician. This difference was strongly and positively correlated with Pain (r=0,737, p<0,001), Fatigue (r=0,646, p<0,001), mobility (r=0,639; p<0,001), Function (r=0,472, p<0,001) and deformity (r=0,459, p<0,001) and also with anxiety (r=0,551, p<0,001) and depression (r=0,464, p<0,001). A weak negative correlation was observed with Happiness (r=-0,269, p=0,008). The discrepancy was also negatively correlated with 28 tender joint count (TJC28) (r=-0,246, p=0,047), but not with SJC or CRP. In the multivariate analysis only pain (β=0,7, 95%CI: 0,526-0,876, p<0,001), anxiety (β=1,807, 95%CI: 0,688-2,926, p<0,002) and TJC (β=-1,1169; 95%CI: -2,34,-0,15, p<0,002) remained as independent predictors, explaining around 62%, of the discordance (R=0,624, p<0,001).
Conclusions Patients rate disease activity higher than their physicians. Higher scores in pain and anxiety were associated with higher degrees of discordance. Recognizing this difference and its predictors can guide interventions to improve care of RA patients.
Disclosure of Interest None declared