Session Information
Session Title: Rheumatoid Arthritis - Clinical Aspects: Novel Biomarkers and Other Measurements of Disease Activity
Session Type: Abstract Submissions (ACR)
Background/Purpose
Patients with rheumatoid arthritis (RA) sometimes rate their global disease activity differently than their rheumatologists. Previous studies describing this ‘discordance’ have primarily included patients with established disease (i.e., mean disease duration >10 years). The objective of this study was to evaluate the prevalence and correlates of patient-physician discordance in patients with early disease (i.e., duration <3 years).
Methods
We conducted an observational study of consecutive patients with RA recruited between July 2008 and December 2010. RA was defined by the Leiden early RA prediction rule or the 1987 ACR criteria. A physician joint assessor, who was independent from treatment decision-making, performed a standardized clinical evaluation. Discordance was defined by a ≥25-mm difference between the patient and physician global assessments of disease activity. A higher patient-than-physician global assessment defined positive discordance, and a higher physician-than-patient global assessment defined negative discordance. Patients completed visual analog scales for pain and fatigue, the Health Assessment Questionnaire (HAQ), and the Medical Outcomes Study Short Form 36 (SF-36). We abstracted the electronic medical records to collect demographics, laboratory data, smoking status, and body mass index (kg/m2). Correlations between explanatory variables and the presence of positive or negative discordance were determined using Spearman methods.
Results
A total of 127 patients with RA were recruited. The mean age was 55.6 years, mean disease duration was 6.8 months, and 63% of patients were female. The prevalence of positive (i.e., patient high) and negative (i.e., physician high) discordance was 10.2% and 16.5%, respectively. Positive discordance was associated with higher pain (r = 0.37, p = <0.001), fatigue (r = 0.32, <0.001) and HAQ disability (r = 0.31, p<0.001). Poor health-related quality of life on the SF-36 physical component scale (r = -0.29, p = 0.001) and mental component scale (r = -0.20, p = 0.02) also correlated with positive discordance. Notably absent were associations of discordance with age, sex, radiographic damage, body mass index, smoking, anti-CCP antibodies, or use of prednisone or disease-modifying medications. In contrast, negative discordance (i.e., physician high) was associated with higher numbers of swollen joints (r = 0.19, p = 0.03), positive rheumatoid factor (r = 0.18, p = 0.046), and with lower pain and better overall physical and mental health on the part of the patient.
Conclusion
The contribution of this study is that prevalence and correlates of patient-physician discordance are similar in early and established RA. Patients with early RA take into account their pain, fatigue and adverse quality of life when making their global disease assessments whereas physicians emphasize objective inflammation and laboratory markers. As ‘treat-to-target’ algorithms increasingly focus on quantitative targets, these data behoove clinicians to fully consider the disease experience to provide optimal patient care.
Disclosure:
J. M. Davis III,
None;
C. S. Crowson,
None;
T. Bongartz,
None;
C. J. Michet,
None;
E. L. Matteson,
None;
S. E. Gabriel,
None.
« Back to 2014 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - http://acrabstracts.org/abstract/prevalence-and-correlates-of-patient-physician-discordance-in-early-rheumatoid-arthritis/