ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2279

Assessment Of Global Disease Activity In Rheumatoid Arthritis By Patients and Physicians: Cultural Differences Among Countries In The Meteor Database

E. Gvozdenovic1, R. Wolterbeek2, C.F. Allaart1, Claiton Brenol3, Arvind Chopra4, Maxime Dougados5, Paul Emery6, D. van der Heijde7, T.W.J. Huizinga1, Jonathan Kay8, Emilio Martín Mola9, Robert J. Moots10, José A. P. Da Silva11, Josef S. Smolen12, Douglas J. Veale13 and R. Landewe14, 1Rheumatology, Leiden University Medical Center, Leiden, Netherlands, 2Biostatistics, Leiden University Medical Center, Leiden, Netherlands, 3Universidade Federal do Rio Grande do Sul, Porto Alegre RS, Brazil, 4Rheumatology, Center for Rheumatic Diseases, Pune, India, 5Rheumatology B Department, Paris-Descartes University, Cochin Hospital, Paris, France, 6Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom, 7Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands, 8UMass Memorial Medical Center and University of Massachusetts Medical School, Worcester, MA, 9Rheumatology. La Paz Hospital. IdiPaz, Madrid, Spain, 10Clinical Sciences Centre, University of Liverpool, Liverpool, United Kingdom, 11Serviço de Reumatologia, Centro Hospitalar e Universitário de Coimbra – Hospitais da Universidade de Coimbra, E.P.E., Coimbra, Portugal, 12Medical University of Vienna, Vienna, Austria, 13Rheumatology, St. Vincent's University Hospital, Dublin 4, Ireland, 14Division of Clinical Immunology and Rheumatology, Academic Medical Center / University of Amsterdam, Amsterdam, Netherlands

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: ,

Session Information

Title: Rheumatoid Arthritis-Clinical Aspects III: Outcome Measures, Socioeconomy, Screening, Biomarkers in Rheumatoid Arthritis

Session Type: Abstract Submissions (ACR)

Background/Purpose: Dissonant perceptions of disease activity between rheumatoid arthritis (RA) patients and their rheumatologists may influence treatment decisions. The discordance between patient’s and physician’s global disease activity assessment (PtGDA and PhGDA, respectively) may vary by country because of cultural differences. Our aim is to compare the differences between PtGDA and PhGDA among 13 countries in the METEOR database.

Methods: The Measurement of efficacy of Treatment in the Era of Rheumatology (METEOR) database, a worldwide online tool for disease monitoring in RA, was used to anonymously select 14,020 patients during the period between 2008 and 2012. PtGDA and PhGDA were scored independently on a 100 mm visual analogue scale (VAS) with 0 and 100 as extremes. Linear Mixed Models (LMM) were used to estimate the mean differences between PtGDA and PhGDA score in13 countries (Brazil, Czech Republic, Spain, France, United Kingdom , Ireland, Italy, Latvia, Mexico, Pakistan, Portugal, United States, and the Netherlands), adjusted for DAS. Generalized Estimated Equation (GEE) was used to model differences (>20mm) between PtGDA and PhGDA score as the outcome and countries as determinants, corrected for DAS.

Results: Mean difference between PtGDA and PhGDA score differs by country, varying from -2 mm (physician scores higher) in Mexico to 14 mm (patient scores higher) in Brazil (Figure 1), independent of DAS. GEE indicated that ‘country’ was a significant determinant of the difference between PtGDA and PhGDA score, independent of differences in DAS. With the Netherlands as a reference, PtGDA and PhGDA scores differ significantly within the same patient in almost all countries (Brazil, Czech Republic, Great Britain, Ireland, Italy, Latvia, Mexico, Pakistan, Portugal and United States).

Conclusion: We find differences between patients’ and physicians’ assessment of global disease activity, the magnitude of which varies depending upon the country in which the patient and the physician both reside. Cultural influences must be taken into account when interpreting discordances between the patient’s and the physician’s assessment of global disease activity in RA. Although the magnitude differs across countries, patients nearly always assess global disease activity to be worse than do their physicians.

                                                                               

Disclosure:

E. Gvozdenovic,
None;

R. Wolterbeek,
None;

C. F. Allaart,
None;

C. Brenol,
None;

A. Chopra,
None;

M. Dougados,
None;

P. Emery,
None;

D. van der Heijde,
None;

T. W. J. Huizinga,
None;

J. Kay,
None;

E. Martín Mola,
None;

R. J. Moots,
None;

J. A. P. Da Silva,
None;

J. S. Smolen,
None;

D. J. Veale,
None;

R. Landewe,
None.

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