Session Title: Rheumatoid Arthritis - Clinical Aspects Poster Session III
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
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
The aim of this study was to explore the
extent and reasons for this discordance.
-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.
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.
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.
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 April 7, 2020.
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