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Abstract
Background Patient-provider discordance in assessment of disease status has been linked to lower patient satisfaction with potential implications on patient compliance and outcomes of care. Global assessment (GA) of disease activity in rheumatoid arthritis (RA) is discordant between patient and provider in about one third of cases. Prospective studies evaluating the implications of patient-provider discordance on RA disease course are lacking.
Objectives We aimed to assess the occurrence and severity of patient-reported flares of RA in patients who had discordant estimates of RA disease activity with their provider at baseline compared to those who had concordant estimates.
Methods Patients with RA (age≥18 years; 2010 ACR criteria) participating in an ongoing prospective study underwent clinical evaluation by a rheumatology provider (MD/NP/PA) at baseline with assessment of tender (TJC28) and swollen joint counts (SJC28), C-reactive protein (CRP), patient and provider GA of RA disease activity, disease activity score (DAS28-CRP), clinical disease activity index (CDAI), completion of Health Assessment Questionnaire-II (HAQ-II), visual analogue scales (0–100 mm) for pain (VAS-pain) and the flare-assessment in RA (FLARE) questionnaire. Patient-provider discordance was defined as ≥25 mm difference in GA between the patient and provider. Occurrence of patient-reported RA flares was compared between patients with and without discordance in GA. Flare was defined based on patient report when answered “Yes” to the question “Are you having a flare of your RA at this time?” or a predefined cut-off ≥2.5 on FLARE questionnaire (1,2).
Results The study included 55 patients with RA (mean age 60.7 years; 65% female), of whom 40 had GA concordant with their provider and 15 had higher GA than their provider. Table 1 summarizes patient characteristics depending on GA discordance at baseline. Patients with discordance were similar in age, sex, duration of follow-up, had similar TJC28 and SJC28, but had significantly higher HAQ-II, VAS-pain, CRP, DAS28, CDAI, provider GA and FLARE scores at baseline vs patients with concordant GA. During the follow up, patients with discordance had significantly higher numbers and rates of flares, and tended to have more visits with discordant GAs compared to patients who had concordant GA with their provider at baseline.
Conclusions Patients with patient-provider discordance at baseline were more likely to report flares of RA during follow-up. Patient-provider discordance tended to persist at follow-up visits. Disease activity assessments with patient-reported component (i.e., HAQ-II, VAS-pain, DAS28, CDAI, FLARE score), as well as CRP and provider GA, but not joint counts, were higher at baseline in patients with discordance. Consideration of the results of clinical and laboratory assessment in combination with patient-reported measures of RA disease activity may be important to inform future risk of flares in patients with RA and help improve patient-provider communication and shared decision making.
References
Myasoedova E, et al. Identifying Flare in Rheumatoid Arthritis: What Is the Threshold? [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10).
De Thurah A, et al. Patient self-assessment of flare in rheumatoid arthritis: criterion and concurrent validity of the Flare instrument. Clin Rheum. 2016; 35: 467–71.
References
Disclosure of Interest None declared