Background/Purpose: Instruments to measure rheumatoid arthritis (RA) activity such as the 28-Joint Disease Activity Score (DAS28) are used to assess response to treatment. One component of the DAS28 is the patient global assessment of general health. This is a subjective measurement that has been shown to be influenced by multiple factors such as depression. Moreover, some studies have reported discordance between patient and physician ratings of general health; however, the factors associated with these discrepancies have not been well established. The aims of this study were to determine the level of discordance of patient-physician assessments of general health in a group of US Hispanics with RA, and to evaluate the factors associated with such discordance.

Methods: A cross-sectional study was conducted in 213 US Hispanics with RA (per 1987 ACR criteria) participating in an observational study. Demographic parameters, clinical manifestations, disease activity (per DAS28), comorbid conditions, functional status (per Health Assessment Questionnaire [HAQ]), pharmacologic profile, and patient and physician global assessments (measured on a visual analogue scale [VAS]) were determined. Positive discordance of general health was defined as a patient rating minus physician rating >25 mm on a 100-mm VAS. Differences between study groups were evaluated using multivariable logistic regression analysis. All variables with a p≤0.10 in the bivariable analysis plus age, gender and disease duration were entered into the regression model.

Results: The mean (standard deviation [SD]) age of RA patients was 56.6 (13.6) years; 88.0% were females. The mean (SD) disease duration was 11.2 (10.0) years. Positive patient-physician discordance was found in 78 (36.6%) patients. Only 2 patients exhibited negative discordance. In the multivariable analysis, patients with positive discordance were more likely to have a higher global assessment of pain (OR=1.05, 95% CI 1.03-1.07, p<0.001) and HAQ scores (OR=3.19, 95% CI 1.70-6.00, p<0.001), and were more likely to receive therapy with biologic agents (OR=3.06, 95% CI 1.40-6.71, p=0.005) than those without discordance. Conversely, patients with positive discordance had lower physician’s assessment of function (OR=0.96, 95% CI 0.93-0.98, p=0.002). No association was found for comorbidities including depression and fibromyalgia syndrome.

Conclusion: In this group of patients with RA, a large number differed from their physicians in the assessment of general health. Positive discordance was associated with patients’ self-report of pain and disability, and the use of biologics. The awareness of these factors may help to better assess disease activity and treatment response in this population.

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ACR Meeting Abstracts - http://acrabstracts.org/abstract/discordance-of-patient-physician-assessments-of-general-health-in-a-us-hispanic-population-with-rheumatoid-arthritis/