Session Type: ACR Concurrent Abstract Session
Session Time: 11:00AM-12:30PM
Background/Purpose: In the management of chronic diseases, recommendations insist on the need to work in partnership with the patient. Patient-physician discordance in global assessment of disease activity is frequent but what does it reflect? The objectives of this study were to assess patient-physician discordance in global assessment in psoriatic arthritis (PsA), predictors of discordance (including patient reported domains of health) and the frequency of discordance according to disease activity levels.
Methods: The PsAID cross-sectional multicenter European study of patients with PsA according to expert opinion was analysed. Patient- and Physician-Global Assessment (PGA and PhGA) were rated with a 0-10 numeric rating scale. Discordance was defined as the difference (PGA–PhGA) and as the absolute difference |PGA-PhGA|≥3 points in the whole population and according to Disease Activity index for PSoriatic Arthritis (DAPSA) levels. Determinants of (PGA-PhGA) were assessed by a stepwise multivariate linear regression among 12 physical and psychological aspects of impact (pain, skin problems, fatigue, ability to work/leisure, functional incapacity, feeling of discomfort, sleep disturbance, anxiety/fear, coping, embarrassment/shame, social participation and depressive affects). A sensitivity analysis was also performed with a logistic regression model using the binary variable |PGA-PhGA|≥3 as outcome. There was no imputation of missing data.
Results: In 460 patients (mean age 50.6±12.9 years, 52.2% female, mean disease duration 9.5±9.5 years, mean DAPSA 30.8±32.4), mean PGA was higher than mean PhGA with a mean absolute difference of 1.9±1.8 points. Discordance defined by |PGA-PhGA|≥3 points concerned 134 (29.1%) patients and 115 (85.8% of patients with discordance) had PGA>PhGA. Higher fatigue (β=0.14), lower self-perceived coping (β=0.23) and impaired social participation (β=0.16) were independently associated with a higher difference (PGA-PhGA). The sensitivity analysis using |PGA-PhGA|≥3 as outcome shows that coping (OR=1.34, impaired social participation (OR=1.28) and depressive affects (OR=1.18) were related with discordance. According to DAPSA, more patients with discordance were in remission (30.8%) compared to high disease activity (26.1%).
Conclusion: Discordance concerned 29.1% of these PsA patients, which is less frequent than in rheumatoid arthritis (around 43%). Mean PGA was higher than mean PhGA. Factors associated with discordance were psychological rather than physical domains of health. Unlike most published articles on patient-physician discordance in RA, pain was not a predictive factor in this study, perhaps due to links with other outcomes. The patient’s ability to self-manage seems to be important. Discordance was more frequent in patients in remission, indicating the meaning of remission should be further explored in PsA.
To cite this abstract in AMA style:Desthieux C, Granger B, Balanescu AR, Balint P, Braun J, Canete J, Heiberg T, Helliwell PS, Kalyoncu U, Kvien TK, Kiltz U, Niedermayer D, Otsa K, Scrivo R, Smolen J, Stamm TA, Veale DJ, de Vlam K, de Wit M, Gossec L. Determinants of Patient-Physician Discordance in Global Assessment in Psoriatic Arthritis and Levels of Discordance According to Disease Activity: A Multicenter European Study [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/determinants-of-patient-physician-discordance-in-global-assessment-in-psoriatic-arthritis-and-levels-of-discordance-according-to-disease-activity-a-multicenter-european-study/. Accessed August 4, 2021.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/determinants-of-patient-physician-discordance-in-global-assessment-in-psoriatic-arthritis-and-levels-of-discordance-according-to-disease-activity-a-multicenter-european-study/