Background/Purpose:  In Rheumatoid Arthritis it has been observed a significant discrepancy in the global assessment of the disease by the patient and physician and this was not extensively evaluated in patients with Psoriatic Arthritis (PsA). The purpose of our study was to evaluate the agreement and the variables that influence global disease assessment by the patient (PGA) and physician (PhGA) in patients with PsA

Methods:  Patients with PsA according to CASPAR criteria ≥ 18 years, belonging to RAPSODIA (Registro de Artritis Psoriática IREP, Argentina) cohort were included. Demographic data, clinical features and treatment received were recorded. Peripheral joint assessment was performed by counting 66/68 swollen/tender joints and the following indexes were calculated DAS28, DAPSA, CPDAI and MDA. Cutaneous involvement was evaluated by PASI. Morning stiffness, pain and global assessment of disease activity by the patient and physician were assessed using visual analogue scale (VAS 0-10cm). Patients completed BASDAI, HAQ, BASFI, ASQoL and PsAQoL questionnaires.

Results: 110 patients were included, 56 males (50.9%), with a median age of 55 years (IQR 45-63) and median disease duration of 10 years (IQR 6-17). Pain m 5 cm (IQR 2.6-7), PGA m 4.25 cm (IQR 2.13-7) and PhGA m 3 cm (IQR 1.13-5). The PGA had very good correlation with pain (Rho= 0.76), BASFI (Rho= 0.7) and BASDAI (Rho= 0.7) and acceptable with PsAQoL (Rho= 0.56), and had no correlation with the number of swollen and tender joints (Rho: 0.04 and 0.05, respectively). By contrast, the PhGA had a good correlation with pain (Rho= 0.65), BASDAI (Rho= 0.62) and PGA (Rho= 0.64), acceptable with BASFI (Rho= 0.59), number of swollen joints (Rho= 0.52), number of tender joints (Rho: 0.41) and PsAQoL (Rho= 0.43) and low correlation with PASI (Rho= 0.21). In two multiple linear regression analysis, using PhGA and PGA as dependent variables, pain was the main variable that was significantly associated with both of them (βcoef: 0.529, p<0.001 and βcoef: 0.481, p= 0.002, respectively). Taking Minimal Disease Activity (MDA) as a measure of ideal state, we performed a logistic regression analysis, considering MDA as a dependent variable. PGA had a greater association as compared to the physician’s global assessment [OR: 0.61 (95%CI: 0.42-0.89), p= 0.01 vs 0.49 (95%CI: 0.29-0.87), p= 0.02]

Conclusion: The evaluation of the global assessment of disease activity in PsA by the patient and physician showed good correlation. Pain was the variable most strongly influenced both assessments. The evaluation of the disease by the patient had more association with MDA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/concordance-between-patient-and-physician-global-assessment-of-the-disease-in-patients-with-psoriatic-arthritis/