Dr. Bergman has received consultant fees, speaking fees, and/or honoraria (less than $10,000 each) from UCB, Takeda, and Pfizer, and (more than $10,000 each) from Abbott, BMS, and Roche.
Determinants of discordance in patients' and physicians' rating of rheumatoid arthritis disease activity
Article first published online: 25 JAN 2012
Copyright © 2012 by the American College of Rheumatology
Arthritis Care & Research
Volume 64, Issue 2, pages 206–214, February 2012
How to Cite
Khan, N. A., Spencer, H. J., Abda, E., Aggarwal, A., Alten, R., Ancuta, C., Andersone, D., Bergman, M., Craig-Muller, J., Detert, J., Georgescu, L., Gossec, L., Hamoud, H., Jacobs, J. W. G., Laurindo, I. M. M., Majdan, M., Naranjo, A., Pandya, S., Pohl, C., Schett, G., Selim, Z. I., Toloza, S., Yamanaka, H. and Sokka, T. (2012), Determinants of discordance in patients' and physicians' rating of rheumatoid arthritis disease activity. Arthritis Care Res, 64: 206–214. doi: 10.1002/acr.20685
- Issue published online: 25 JAN 2012
- Article first published online: 25 JAN 2012
- Accepted manuscript online: 2 NOV 2011 08:55AM EST
- Manuscript Accepted: 14 OCT 2011
- Manuscript Received: 31 JAN 2011
- Abbott (Finland)
- National Center for Research Resources. Grant Number: Award 1UL1RR029884
To assess the determinants of patients' (PTGL) and physicians' (MDGL) global assessment of rheumatoid arthritis (RA) activity and factors associated with discordance among them.
A total of 7,028 patients in the Quantitative Standard Monitoring of Patients with RA study had PTGL and MDGL assessed at the same clinic visit on a 0–10-cm visual analog scale (VAS). Three patient groups were defined: concordant rating group (PTGL and MDGL within ±2 cm), higher patient rating group (PTGL exceeding MDGL by >2 cm), and lower patient rating group (PTGL less than MDGL by >2 cm). Multivariable regression analysis was used to identify determinants of PTGL and MDGL and their discordance.
The mean ± SD VAS scores for PTGL and MDGL were 4.01 ± 2.70 and 2.91 ± 2.37, respectively. Pain was overwhelmingly the single most important determinant of PTGL, followed by fatigue. In contrast, MDGL was most influenced by swollen joint count (SJC), followed by erythrocyte sedimentation rate (ESR) and tender joint count (TJC). A total of 4,454 (63.4%), 2,106 (30%), and 468 (6.6%) patients were in the concordant, higher, and lower patient rating groups, respectively. Odds of higher patient rating increased with higher pain, fatigue, psychological distress, age, and morning stiffness, and decreased with higher SJC, TJC, and ESR. Lower patient rating odds increased with higher SJC, TJC, and ESR, and decreased with lower fatigue levels.
Nearly 36% of patients had discordance in RA activity assessment from their physicians. Sensitivity to the “disease experience” of patients, particularly pain and fatigue, is warranted for effective care of RA.