Background Psoriatic arthritis (PsA) is a chronic inflammatory arthritis associated with psoriasis, axial involvement, enthesitis, dactylitis and uveitis. The differences and similarities between patient's global assessment (PtGA) and physician's global assessment (PhGA) were not assessed clearly in PsA.
Objectives The aim of this study was to assess differences and similarities between patient's and physician's perspective of global assessment in patients with PsA.
Methods Patients with PsA over the age of 18-year-old who met the CASPAR classification criteria were underwent clinical and laboratory evaluation by using standardized protocol and case report form, from two universities outpatient's clinics. PtGA and PhGA, VAS-pain, fatigue, BASDAI, BASFI, health-related QoL were recorded at baseline visit. Pearson correlation coefficient were calculated for PtGA and PhGA. Linear regression model were used to asses relationship between global assessments and clinical finding.
Results A total 144 patients with PsA (male 51, female 93) were included. Symptom duration (7.8±7.5 vs 11.3±11.2), VAS-pain (4.4±2.6 vs 4.9±2.6), PtGA (4.7±2.5 vs 5.0±2.4) and PhGA (4.0±2.2 vs 4.4±2.2) were similar between male and female patients with PsA (p>0.05). VAS-fatigue was higher in female patients with PsA than male ones (5.9±2.7 vs 4.4±2.8, p=0.001). Disease activity measurements such as, tender and swollen joint count, DAS28, BASDAI and acute phase reactant were similar for both sex. Correlation coefficient of Physician's global assessment was higher than PtGA in various clinical findings. The highest correlation coefficient was observed in VAS-pain (r=0.784) and followed by SF36-bodily pain (r=-0.613), BASDAI (r=0.587), NHP-physical activity (r=0.584), VAS-fatigue (r=0.555), BASFI question 5 (r=0.551) for PhGA (p<0.0001). However the highest correlation coefficient was observed in VAS-pain (r=0.690) and followed by NHP-physical activity (r=0.536), BASFI question 10 (r=0.512), BASDAI (r=0.499), SF36 (r=-0.490) and BASFI total score (r=0.484) for PtGA (p<0.0001). Statistically significant positive linear relation was observed between global assessment and clinical parameters (VAS-pain, fatigue, BASDAI, BASFI, DAS28, NHP-physical activity) by using simple linear regression model. VAS-pain and BASDAI question 1 explained 83.3% of PtGA as a predictor in multiple linear regression model. However, VAS-pain and DAS28 explained 68.4% of PhGA as a predictor in multiple linear regression model (table 1).
Conclusions Assessment of disease activity as well as clinical parameters is considered to be complex in PsA. Patient's and physician's have different perspective of disease activity. Severity of pain and fatigue may be predictor of PtGA whereas; pain and objective disease activity measurement may be predictor of PhGA in patient with PsA.
Disclosure of Interest None declared