Background The integration of the patient in therapeutic decisions (shared decision-making) is an important aspect of management of chronic inflammatory diseases. However, the patient's opinion does not always reflect the physician's opinion. Patient-physician discordance in the global assessment of disease can lead to patient dissatisfaction regarding treatment decisions and negatively affect medical care with potentially poor adherence, and costs for society. Published data on patient-physician discordance appears heterogeneous.
Objectives The aim of our study was to assess in the published literature the discordance between patients and physicians in the global assessment of rheumatoid arthritis (RA).
Methods A systematic review of articles published from January 2000 to January 2015 was performed using PUBMED. Keywords used were [rheumatoid arthritis and (discordance or discrepancy) and global assessment]. The outcomes collected were i) definitions used for discordance, ii) percentage of discordance and iii) drivers of global assessment.
Results In all, 15 articles were identified, 7 were selected. The 7 articles reported on 8532 patients. The weighted mean age was 55.5±13.8 years, 80.5% were women, weighted mean RA duration was 10.8±9.6 years. Five articles (71%) had a cut-off. The cut-off defined as the absolute difference between patient global assessment and physician global assessment was very heterogeneous varying between 0.5 to 3cm on 0-10 visual analog scale. The mean percentage of patients with discordance was 40.3% but varied between 36% and 76%; there was more discordance with a lower cut-off to define discordance. However, a cut-off of 2cm versus 2.5cm or 3cm didn't change the percentage of discordance (around 36%). The drivers of patient global assessment were pain and functional incapacity. Whereas, drivers of physician global assessment were acute phase reactants (ESR, CRP), tender and swollen joints count.
Conclusions Discordance has a heterogeneous definition in literature. Around one third of patients with RA have a significant discordance with the physician in global asseessment of disease.
This work suggests that patient global assessement is based more heavily on patients' subjective perception of pain and functional incapacity. In contrast, physicians are more focused on “RA-specific outcomes” and such as swollen and tender joints count and acute phase reactants. Taking into account the patient perspective is important but aspects such as widespread pain syndrome, personal factors and culture may play a role in discordance.
Disclosure of Interest None declared