Factors Explaining the Discrepancy Between Physician and Patient Global Assessment of Joint and Skin Disease Activity in Psoriatic Arthritis Patients
Article first published online: 27 JAN 2015
Copyright © 2015 by the American College of Rheumatology
Arthritis Care & Research
Volume 67, Issue 2, pages 264–272, February 2015
How to Cite
Eder, L., Thavaneswaran, A., Chandran, V., Cook, R. and Gladman, D. D. (2015), Factors Explaining the Discrepancy Between Physician and Patient Global Assessment of Joint and Skin Disease Activity in Psoriatic Arthritis Patients. Arthritis Care Res, 67: 264–272. doi: 10.1002/acr.22401
- Issue published online: 27 JAN 2015
- Article first published online: 27 JAN 2015
- Accepted manuscript online: 21 JUL 2014 12:41PM EST
- Manuscript Accepted: 8 JUL 2014
- Manuscript Received: 21 JAN 2014
- The Arthritis Society
- Canadian Institutes of Health Research
- Krembil Foundation
- Canadian Institutes of Health Research Fellowship
- Canadian Institutes of Health Research Clinical Research Initiative Fellowship
To assess the extent and determinants of discordance in scoring between patient global assessment (PtGA) and physician global assessment (PhGA) in patients with psoriatic arthritis (PsA).
A cross-sectional and longitudinal analysis of data was conducted in patients attending a large PsA clinic. The difference between PtGA and PhGA (each measured on a scale of 0–10, with 0 indicating best status and 10 indicating worst status) reflected the discrepancy between the PtGA and PhGA of joint and skin activity and could take values from −10 (higher rating of disease activity by the patient) to 10 (higher rating of disease activity by the physician). Multivariate regression identified variables that contributed significantly to each of the outcomes. The proportion of variability of each outcome explained by each predictor was expressed by the partial R2.
A total of 565 patients were included in the analysis. Patients tended to score their disease worse than their physicians, with greater discordance for the joints than for the skin (mean ± SD 1.68 ± 2.41 PtGA–PhGA difference for joints, and 0.77 ± 2.66 for skin). Fatigue accounted for 21% of the variation in the difference between PtGA and PhGA for joints. Pain ( = 9%) and disability by Short Form 36 health survey ( = 1.2%) were also important factors, each of which led to higher patient rating; whereas increased tender joint count ( = 16%) and swollen joint count ( = 1.4%) resulted in a higher physician rating of arthritis.
Fatigue, pain, disability, and tender and swollen joint counts were the most important factors contributing to discrepancy between patient and physician assessment of joint activity.