Session Information
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Patients and
physicians often differ in their perceptions of disease activity in Rheumatoid arthritis (RA) as described
by patients’ and evaluators’ global assessments (PGA and EGA respectively),
mostly assessed in Caucasians. We evaluated determinants of PGA and EGA and
their proportionate contributions in Latinos with RA in the US. We further
explored predictors of discrepancies between PGA and EGA, and interrogated the
frequencies of concordant and discordant assessments of changes in PGA and EGA
longitudinally.
Methods: We assessed
333 Latinos with RA and follow up in a single center. EGA and PGA were captured
on a 0-10 cm visual analogue scale; discordance was defined as difference >2
cm between the 2 assessments. Linear regression models evaluated predictors of PGA
and EGA, and relative importance weights were calculated for their
proportionate contribution to PGA and EGA variance. Logistic regression models interrogated
predictors of both patient and physician higher ratings respectively.
Results: Our models explained 66% of variability in PGA and 83% of the
variability in EGA. Main, multivariate determinants for PGA were fatigue
(23.7%), pain (21.2%), depression (18%), and sedimentation rate- ESR (3.2%).
EGA was mainly predicted by swollen joint counts (44.4%), tender joint counts
(30.2%), ESR (5.2%) and fatigue (3.5%). Concordance was observed in 142 (43%),
higher patient ratings in 147 (44%), and higher physician ratings in 44 (13%). Fatigue
and pain predicted higher patient ratings, while swollen joints, tender joints,
and prednisone use predicted higher physician ratings (table 1). At follow up,
EGA improved in 31.7%, remained unchanged in 50.9% and worsened in 17.4%.
Respective trends for PGA were 28.6%, 44.1% and 27.3%. The lowest concordance
was seen for worsening disease, where PGA showed only 27% concordance with the
EGA, compared to 59% and 52% for unchanged or improved disease respectively.
Conclusion: Highly
divergent parameters shape patients’ and physicians’ perceptions of disease
activity in Latinos with RA in the US; fatigue and pain contribute mainly to
higher patient assessments, while swollen and tender joint counts predict
higher physician assessments. Patient education of what determines long-term disability,
and a better physician grasp of the patient perspective will likely foster
shared decision-making and compliance with treat to target initiative.
Table 1: Predictors
of discordant Patient –Physician Assessments of global disease activity
|
Higher PGA (PGA – EGA > 2cm) |
|
Higher EGA (EGA – PGA > 2cm) |
||||||||||
|
Unadjusted OR (95% CI) |
|
Adjusted OR (95% CI) |
|
Unadjusted OR (95% CI) |
|
Adjusted OR (95% CI) |
||||||
|
Age |
1.02
|
(1.00 -1.04) |
|
|
|
1.01
|
(0.98 -1.04) |
|
|
|||
|
Gender |
1.29
|
(0.61 -2.73) |
|
|
|
0.86
|
(0.32 -2.34) |
|
|
|||
|
Disease duration |
0.98
|
(0.95 -1.01) |
|
|
|
0.99
|
(0.95 -1.03) |
|
|
|||
|
RF positive |
0.46
|
(0.19 -1.09) |
|
|
|
0.32
|
(0.11 -0.93) |
|
0.56
|
(0.11 -2.81) |
||
|
CCP positive |
0.64
|
(0.31 -1.34) |
|
|
|
0.53
|
(0.20 -1.43) |
|
|
|||
|
Erosions |
1.04
|
(0.66 -1.65) |
|
|
|
1.61
|
(0.80 -3.23) |
|
|
|||
|
IAD present |
1.25
|
(0.75 -2.10) |
|
|
|
0.72
|
(0.31 -1.63) |
|
|
|||
|
Fibromyalgia |
1.87
|
(1.01 -3.48) |
|
0.90
|
(0.38-2.10) |
|
0.47
|
(0.13 -1.68) |
|
|
||
|
n-TJC |
0.94
|
(0.89 -0.99) |
|
0.87
|
(0.79 -0.95)** |
|
1.21
|
(1.13 -1.29) |
|
1.16
|
(1.05 -1.28)** |
|
|
n-SJC |
0.80
|
(0.73 -0.88) |
|
0.64
|
(0.54 -0.75)*** |
|
1.38
|
(1.25 -1.52) |
|
1.34
|
(1.18 -1.53)*** |
|
|
ESR |
1.00
|
(0.99 -1.01) |
|
|
|
1.02
|
(1.00 -1.03) |
|
1.00
|
(0.98 -1.02) |
||
|
Prednisone |
1.23
|
(0.75 -2.02) |
|
|
|
3.13
|
(1.56 – 6.29) |
|
3.14
|
(1.15 -8.55)* |
||
|
n-DMARDs |
0.97
|
(0.77 -1.23) |
|
|
|
0.81
|
(0.57 – 1.14) |
|
|
|||
|
Biologics |
1.17
|
(0.73 -1.88) |
|
|
|
1.63
|
(0.83 – 3.22) |
|
|
|||
|
HAQ-DI |
1.80
|
(1.35 -2.41) |
|
1.31
|
(0.84-2.04) |
|
1.72
|
(1.16 – 2.57) |
|
1.21
|
(0.61 -2.4) |
|
|
Pain-VAS |
2.07
|
(1.53 -2.79) |
|
2.06
|
(1.23 -3.46)*** |
|
1.55
|
(1.01 – 2.38) |
|
0.29
|
(0.12 -0.69)** |
|
|
PHQ-9 |
1.10
|
(1.06 -1.15) |
|
1.05
|
(0.99 -1.12) |
|
1.02
|
(0.96 -1.08) |
|
|
||
|
FACIT |
1.26
|
(1.16 -1.37) |
|
1.30
|
(1.12 -1.49)*** |
|
1.09
|
(0.97 -1.22) |
|
|
||
*p<0.05, **p<0.01, ***p<0.001
To cite this abstract in AMA style:
Karpouzas GA, Draper T, Hernandez E, Ormseth S. Determinants of Patient- Physician Discordance in Assessment of Global Disease Activity in Latinos with Rheumatoid Arthritis in the United States [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/determinants-of-patient-physician-discordance-in-assessment-of-global-disease-activity-in-latinos-with-rheumatoid-arthritis-in-the-united-states/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/determinants-of-patient-physician-discordance-in-assessment-of-global-disease-activity-in-latinos-with-rheumatoid-arthritis-in-the-united-states/