Background/Purpose: In the discussion of the 2010 ACR/EULAR remission criteria  the issue has been raised to what extent patients are able to distinguish rheumatoid arthritis (RA) related disease activity from global health assessment. It was proposed that co-morbidity is a major driver of poor self-assessed global health when exceeding disease activity.

Methods: We used cross-sectional data of 2,242 RA patients, enrolled in the National Database of the German Collaborative Arthritis Centres between 2005 and 2010, for whom both self-assessed disease activity [VAS 0-100] and global health [NRS 0-10] were documented. Patients who were seen in more than one year were included only once. For comparison, the disease activity scale was transformed to NRS 0-10.

Results: 75% of the patients were female, their mean age was 62.3 years, the median disease duration 7.9 years. For 1,673 patients (75%) the ratings of disease activity and of global health were equal, 213 (10%) rated global health better and 356 (16%) worse. While mean global health scores in these three groups were rather similar, disease activity ratings revealed remarkable differences. Patients who rated their global health worse than their current disease activity were more frequently male, had low mean self-assessed disease activity, and a low DAS28 score. Their pain scores were, however, above their self-assessed disease activity.  The proportions of patients with co-morbid conditions were comparable between the groups that rated “better” and “worse”, but higher for those patients who gave the same scores for global health and disease activity. For patients with comorbid conditions, the average number of comorbid conditions was higher in patients who rated their global health better than those who rated worse.

Table 1: Characteristics of patients with better, the same or worse global health rating when compared to self-assessed disease activity. Displayed are mean (and median) if not indicated otherwise.

	Patient’s assessment: global health compared to disease activity
	better	the same	worse
N [% of all 2,242 patients]	213 [9.5%]	1,673 [74.5%]	356 [15.9%]
Male	25%	24%	31%
Age, years	61.1	62.7	60.9
Disease duration, years	8.6 (5.6)	10.9 (8.8)	9.3 (6.0)
Patient ass. disease activity [NRS 0-10]	5.1 (5.0)	4.5 (5.0)	2.2 (2.0)
Patient ass. global health [NRS 0-10]	3.3 (3.0)	4.5 (5.0)	4.1 (3.5)
Pain [NRS 0-10]	4.1 (4.0)	4.5 (5.0)	3.6 (3.0)
Number of tender joints	2.0 (0.0)	1.7 (0.0)	1.0 (0.0)
Number of swollen joints	1.3 (0.0)	1.2 (0.0)	0.9 (0.0)
ESR	26.1 (18.0)	22.9 (17.0)	22.9 (16.0)
CRP	1.4 (0.6)	1.0 (0.4)	1.0 (0.4)
DAS28(ESR, global health)	3.2 (3.0)	3.2 (3.0)	3.0 (2.8)
Physician ass. disease activity [NRS 0-10]	2.0 (1.0)	1.5 (1.0)	1.4 (1.0)
With comorbidity	66%	81%	68%
Number of comorbidities if any	2.5 (2.0)	2.6 (2.0)	2.1 (2.0)

Conclusion: The majority of patients with RA gave concordant ratings for disease activity and global health. Differences in ratings were mainly driven by higher disease activity, while global health scores were similar between the groups with concordant and discordant ratings. Comorbidity played no recognizable role for differences between both scores.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/comorbid-conditions-do-not-explain-divergent-patient-assessments-of-disease-activity-and-global-health-in-patients-with-rheumatoid-arthritis/