Influence of Large-Joint Involvement on Patient-Physician Discordance in Global Assessment of Rheumatoid Arthritis Disease Activity Analyzed By Novel Joint Index

Tetsuji Sawada¹, Mayu Tago¹, Susumu Nishiyama², Koichiro Tahara¹, Eri Kato³, Hiroaki Mori¹, Haeru Hayashi¹, Jinju Nishino⁴, Toshihiro Matsui⁵ and Shigeto Tohma⁶, ¹Rheumatology, Tokyo Medical University, Tokyo, Japan, ²Rheumatic Disease Center, Kurashiki Medical Center, Okayama, Japan, ³Rheumatology, Tokyo Medical University, Shinjuku Tokyo, Japan, ⁴Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan, ⁵Department of Lifetime Clinical Immunology Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan, ⁶Clinical Research Center for Allergy and Rheumatology, Sagamihara Hospital, National Hospital Organization, Sagamihara, Japan

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: Evaluation, patient-reported outcome measures and rheumatoid arthritis (RA)

Session Information

Date: Tuesday, November 7, 2017

Title: Patient Outcomes, Preferences, and Attitudes Poster III

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: The discordance between patient global assessment (PGA) and physician global assessment (PhGA) of rheumatoid arthritis (RA) disease activity may be problematic in clinical practice. The aim of this study was to identify determinants of this discordance using a nationwide RA database in Japan (NinJa) with special attention to large joint involvement.

Methods: We investigated 12,043 adults with RA and used a discordance cutoff of 3 cm. Large joint involvement was investigated using novel joint indices (x, y, z) and the large joint index (Nishiyama S et al. Rheumatol Int. 2012;32:2569), in which x and y were the indices for upper and lower joints, respectively, and z was for large joint predominance. Predictors of PGA-PhGA discordance and determinants of PGA and PhGA were analyzed by multivariate logistic and linear regression models, respectively. In logistic regression analysis, the odds ratio (OR) for positive discordance (PGA ≥ PhGA by 3 cm) was computed using a concordance (no discordance) group as reference.

Results: Multivariate logistic regression identified age (OR: 1.01 [95% confidence interval: 1.01–1.02]), pain (2.15 [2.08–2.22]) and modified Health Assessment Questionnaire score (1.56 [1.39–1.75]) as significant predictors of positive discordance. On the other hand, TJC (0.93 [0.91–0.94]), SJC (0.92 [0.90–0.94]), CRP (0.88 [0.83–0.93]), class 3-4 (0.63 [0.53–0.76]), Z (0.72 [0.59–0.88]), and the large joint index (0.59 [0.47–0.74]) predicted significantly against positive discordance. Linear regression analysis demonstrated that PGA was mainly determined by pain, whereas PhGA was determined by various factors, including the large joint index (Figure 1) and Z.

Conclusion: RA care providers should focus on pain, functional disability and the size of affected joints to decrease PGA-PhGA discordance and to share with patients a common recognition of disease activity.

Disclosure: T. Sawada, None; M. Tago, None; S. Nishiyama, None; K. Tahara, None; E. Kato, None; H. Mori, None; H. Hayashi, None; J. Nishino, None; T. Matsui, AbbVie GK, Ayumi Pharmaceutical Corporation, Chugai Pharmaceutical Co., Ltd., CSL Behring K.K., Japan Blood Products Organ, 2; S. Tohma, None.

To cite this abstract in AMA style:

Sawada T, Tago M, Nishiyama S, Tahara K, Kato E, Mori H, Hayashi H, Nishino J, Matsui T, Tohma S. Influence of Large-Joint Involvement on Patient-Physician Discordance in Global Assessment of Rheumatoid Arthritis Disease Activity Analyzed By Novel Joint Index [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/influence-of-large-joint-involvement-on-patient-physician-discordance-in-global-assessment-of-rheumatoid-arthritis-disease-activity-analyzed-by-novel-joint-index/. Accessed .

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