Discrepancies Between Patients and Physicians in Their Perceptions of Rheumatoid Arthritis Disease Activity Are Multifactorial in Early Rheumatoid Arthritis

Cécile Gaujoux-Viala¹, Nathalie Rincheval², Laure Gossec³, Francis Guillemin⁴, Maxime Dougados⁵, Jean-Pierre Daures⁶ and BG Combe⁷, ¹Nîmes University Hospital, Rheumatology Department; EA 2415, Montpellier University, Nîmes, France, ²Biostatistic, EA 2415, Epidemiology unit, Montpellier, France, ³Rheumatology, Pitié Salpetriere Hospital, Paris, France, ⁴University of Lorraine, Nancy, France, ⁵Paris Descartes University, Rheumatology Department, Cochin Hospital, AP-HP. INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France, ⁶Biostatistic, EA 2415 Epidemiology unit, Montpellier, France, ⁷Lapeyronie, Montpellier, France

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Activity score, Early Rheumatoid Arthritis, patient outcomes

Session Information

Date: Tuesday, November 10, 2015

Title: Rheumatoid Arthritis - Clinical Aspects Poster Session III

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose:

Patients and physicians often differ in their perceptions of rheumatoid arthritis (RA) disease activity, as quantified by the patient’s global assessment (PGA) and by the evaluator’s global assessment (EGA).

The aim of this study was to explore the extent and reasons for this discordance.

Methods:

-Patients: from the French cohort of early arthritis ESPOIR (at least 2 swollen joints for less than 6 months, DMARD naïve), fulfilling the ACR-EULAR criteria for RA at baseline

-Analyses: At baseline, agreement between PGA and EGA (Bland-Altman plot) was assessed. Multivariate linear regression was used to analyze data to determine the patient and early arthritis features independently associated with discordance (calculated as PGA – EGA). Logistic regression was used to analyze discordance as│PGA – EGA│≥20.

Results:

In 645 patients with early RA (mean age=48.8±12.2 years, 77% female, 48.7% ACPA +) agreement was better at both ends of the spectrum of the disease activity perception, especially for patients with high disease activity. The direction of the discrepancy usually points toward a higher rating by the patients than by physicians themselves.

In multivariate linear regression center-adjusted, higher PGA has been found to be associated with absence of fulfilling ACR 1987 revised criteria for RA (p=0.0005), higher level of fatigue (p<0.0001) and lower number of swollen joint counts (SJC) (p=0.0022). With logistic regression center-adjusted, low number of SJC (OR 95%CI=0.522 [0.343-0.794]), low mental component of the SF-36 (OR 95%CI=0.550 [0.371-0.815]) and living alone (OR95%CI=0.595 [0.388-0.914]) were associated with discordance between PGA and EGA.

Conclusion:

In early RA, the discordance between PGA and EGA is multifactorial with objective measures like low SJC and absence of fulfilling ACR 1987 revised criteria for RA, but also patient reported outcomes like high level of fatigue and low mental status, and environmental factor: living alone. Understanding the reasons for a discordant view of disease activity will help to facilitate the sharing of decision-making in the management of RA. In addition, our findings represent a call to treat fatigue and anxiety-depression, as this may create better consensus about the course of treatment.

Disclosure: C. Gaujoux-Viala, None; N. Rincheval, None; L. Gossec, None; F. Guillemin, None; M. Dougados, None; J. P. Daures, None; B. Combe, Pfizer, Roche-Chugai, 2,BMS, Merck, Pfizer, Roche-Chugai, UCB, 8.

To cite this abstract in AMA style:

Gaujoux-Viala C, Rincheval N, Gossec L, Guillemin F, Dougados M, Daures JP, Combe B. Discrepancies Between Patients and Physicians in Their Perceptions of Rheumatoid Arthritis Disease Activity Are Multifactorial in Early Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/discrepancies-between-patients-and-physicians-in-their-perceptions-of-rheumatoid-arthritis-disease-activity-are-multifactorial-in-early-rheumatoid-arthritis/. Accessed .

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