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Extended report
Patient-physician discordance in global assessment in early spondyloarthritis and its change over time: the DESIR cohort
  1. Carole Desthieux1,
  2. Anna Molto2,
  3. Benjamin Granger3,
  4. Alain Saraux4,
  5. Bruno Fautrel1,
  6. Laure Gossec1
  1. 1Department of Rheumatology, Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS); AP-HP, Pitié Salpêtrière Hospital, Paris, France
  2. 2Department of Rheumatology, Paris Descartes University, Cochin Hospital, Paris, France
  3. 3Department of Biostatistics, Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS); AP-HP, Pitié Salpêtrière Hospital, Paris, France
  4. 4Department of Rheumatology, CHU Brest, La Cavale Blanche Hospital, Brest, France
  1. Correspondence to Professor Laure Gossec, Department of rheumatology, Hôpital Pitié-Salpétrière, Pavillon Benjamin Delessert 2e étage, 47-83, boulevard de l'Hôpital, Paris 75013, France; laure.gossec{at}aphp.fr

Abstract

Objective To assess patient-physician discordance in global assessment of disease activity in early axial spondyloarthritis (axSpA) over time and determinants of discordance.

Methods DESIR (Devenir des Spondyloarthropathies Indifférenciées Récentes) is a French, multicentre, longitudinal cohort of patients with early inflammatory back pain suggestive of axSpA. Patient global assessment (PGA) and physician global assessment (PhGA) were rated with a 0–10 numerical rating scale, every 6 months during 2 years then at 3 years. Discordance was defined by the absolute difference |PGA–PhGA|≥3 (range 0–10) and was analysed at each visit. Determinants of (PGA−PhGA) were assessed at the visit level by a generalised linear mixed model.

Results A total of 702 patients were analysed at baseline (401 with complete data over 3 years): mean age 33.8±8.6 years, 379 (54.0%) female, mean symptom duration 18.1±10.5 months. Mean PGA values were always higher than mean PhGA values with a mean absolute difference of 1.8 points. At baseline, 202 (28.8%) patients had discordance mainly by PGA>PhGA; over 3 years the frequency of discordance was stable (range 25.5–28.8%). Discordance was not stable at the patient level, 118 (29.4%) patients were discordant once and 88 (22.0%) twice, and only 92 (22.9%) more than twice. Determinants of (PGA−PhGA) were spine pain (β=0.24, p<0.001) and fatigue (β=0.13, p<0.001).

Conclusions Discordance concerned a quarter of patients with early axSpA. Over 3 years of follow-up, discordance did not decrease (no ‘reference shift’). Discordance was not a stable trait, indicating discordance is not a patient characteristic.

  • Spondyloarthritis
  • Disease Activity
  • Epidemiology

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