Assessment of Global Disease Activity in Rheumatoid Arthritis Patients Monitored in the Measurement of Efficacy of Treatment in the Era of Rheumatology Database: The patient’s Versus the rheumatologist’s Opinion

E. Gvozdenovic¹, R. Koevoets¹, R. Wolterbeek², Désirée van der Heijde³, T.W.J. Huizinga¹, C.F. Allaart¹ and Robert B. M. Landewé⁴, ¹Rheumatology, Leiden University Medical Center, Leiden, Netherlands, ²Biostatistics, Leiden University Medical Center, Leiden, Netherlands, ³Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands, ⁴Academic Medical Center/University of Amsterdam & Atrium Medical Center, Amsterdam, Netherlands

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: Outcome measures, patient questionnaires and rheumatoid arthritis (RA)

Session Information

Title: Rheumatoid Arthritis - Clinical Aspects I: Drug Studies/Drug Safety/Drug Utilization/Disease Activity & Remission

Session Type: Abstract Submissions (ACR)

Background/Purpose: Disagreement on disease activity between rheumatoid arthritis (RA) patients and rheumatologists may influence treatment decisions and compliance.

The aim is to compare the physician’s (PhGDA) and patient’s (PtGDA) assessment of global disease activity and to identify factors that might influence these differences over time, as well as factors that may influence the patients and the physicians score separately.

Methods: Anonymous data were used from 2118 Dutch patients included in the Measurement of efficacy of Treatment in the Era of Rheumatology (METEOR) database, a worldwide online tool for disease monitoring in RA. PhGDA and PtGDA were scored independently on a 100 mm visual analogue scale (VAS) with 0 and 100 as extremes. Intra-class correlation coefficients (ICC) were calculated as a measure of agreement and a Bland Altman plot was created to visualize the differences between PhGDA and PtGDA. Linear Mixed Model analysis was used to model PtGDA and PhGDA over time. Logistic repeated measurements were used to model the difference in PtGDA and PhGDA (PtGDA≥PhGDA vs. PtGDAResults: Mean (SD) age was 57 (15) years and 67% of the patients were female. Agreement between PtGDA and PhGDA was moderate (ICC: 0.57). Patients scored on average 11 units higher (worse) than rheumatologists, 95% limits of agreement: -25.2 to 47.6. Patient’s perception of pain (VAS) was positively associated with a PtGDA being higher than PhGDA. Similarly, ESR and swollen joint counts were positively associated with a PhGDA being higher than a PtGDA (Table 1). Both PtGDA and PhGDA were independently associated with tender joint count, swollen joint count, disease duration, and pain (VAS) for pain.

Conclusion: Patients rate global disease activity consistently higher than their rheumatologists. Patients base their judgment primarily on the level of pain; while physicians use SJC and ESR to rate global disease activity.

Table 1: Clinical parameters associated to the difference between PtGDA and PhGDA as a binary dependent variable.*

	PtGDA versus PhGDA*
Variable	Estimate β, 95% CI	p-value
Male	0.16 -0.15, 0.47	0.30
Age	-0.00 -0.01, 0.01	0.46
Disease duration	0.01 -0.01, 0.02	0.23
ESR	-0.01 -0.02 -0.00	<0.01
SJC28	-0.29 -0.36, -0.21	<0.01
TJC28	-0.04 -0.10, 0.02	0.22
VAS pain patient	0.05 0.04, 0.06	<0.01

*1= patient scores equal or higher than the physician; 0= physician scores higher than the patient. (Reference category=0)

Disclosure:

E. Gvozdenovic,
None;

R. Koevoets,
None;

R. Wolterbeek,
None;

D. van der Heijde,
None;

T. W. J. Huizinga,
None;

C. F. Allaart,
None;

R. B. M. Landewé,
None.

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