Discrepancy Between Patient and Physician Global Assessments Over Time in Early Rheumatoid Arthritis

Pooneh Akhavan¹, Vivian P. Bykerk², Juan Xiong³, Janet E. Pope⁴, Boulos Haraoui⁵, J. Carter Thorne⁶, Gilles Boire⁷, Carol A. Hitchon⁸, Diane Tin⁹, Edward Keystone¹⁰ and CATCH¹¹, ¹Rheumatology, University of Toronto, Toronto, ON, Canada, ²Rheumatology, Hospital for Special Surgery, New York, NY, ³Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada, ⁴Medicine, Divsion of Rheumatology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada, ⁵Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada, ⁶Southlake Regional Health Centre, Newmarket, ON, Canada, ⁷Rheumatology Division, Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC, Canada, ⁸University of Manitoba, Winnipeg, MB, Canada, ⁹The Arthritis Program, Southlake Regional Health Centre, Newmarket, ON, Canada, ¹⁰Mount Sinai Hospital, Toronto, ON, Canada, ¹¹Toronto

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: Assessment, outcome measures and rheumatoid arthritis (RA)

Session Information

Title: Rheumatoid Arthritis - Clinical Aspects III: Infections/Risk Factors for Incident Rheumatoid Arthritis/Metrology/Classification/Biomarkers/Predictors of Rheumatolid Arthritis Activity & Severity

Session Type: Abstract Submissions (ACR)

Background/Purpose: Discrepancy between patient (PGA) and physician (MDGA) global assessments in RA can adversely affect therapeutic decisions in many cases. The purpose of this study is to assess whether baseline PGA-MDGA discrepancy predictors change after one year in patients with early RA.

Methods: Patients with RA were recruited from the Canadian Early Arthritis Cohort (CATCH) a prospective cohort where data is collected according to a standardized protocol. CATCH patients were considered for this analysis if they initiated DMARDs at baseline, were biologic naïve and had ≥12 months follow up. PGA and MDGA were scored out of 100. PGA-MDGA discrepancy was calculated by subtracting MDGA from PGA at baseline. A clinically meaningful discrepancy was considered a difference of ≥30 (PGA-MDGA > 30: Positive (Pos) and PGA-MDGA < -30: Negative (Neg)). Linear regression analysis was used to evaluate factors associated with the PGA-MDGA discrepancy, MDGA and PGA when adjusted for potential confounders at baseline and at 1 year separately. To address the variability of the rheumatologists’ influence on the discrepancy we included CATCH recruiting "site" as one of the predictors. Sites with more than 25 patients were considered for analysis.

Results: Baseline characteristics of the 480 RA patients who met inclusion criteria for this study included: 74% female, mean (SD) age 54(14.5), disease duration 0.5(0.24) years, TJC 8.6 (6.8), SJC 8.7 (6.3) (of 28), DAS28 5.2 (1.4), ESR 28.6 (22.6), CRP 15.0 (19.6) mg/L, PGA 58.7 (29.4) and MDGA 51.6 (24.8). Discrepancy rates are shown in Table 1. At baseline significant predictors of PGA-MDGA were Pain (p<.0001), SJC (p<.0001), TJC (p=0.008), ESR (p=0.02) and “site” (p=0.0006). At 12 months significant predictors of PGA-MDGA were Pain (<.0001), SJC (p<.0001), TJC (p=0.02), age (0.04) and “site” (p=0.0002). At baseline PGA was significantly associated with pain, HAQ, SJC, age and “site” and at 12 months with pain and “site” only. Baseline factors associated with MDGA were SJC, TJC, pain, ESR, HAQ and “site” and at 12 months ESR and HAQ were no longer significant.

Table 1. Discrepancy rates at baseline and 12 months (*P<0.05)

	No discrepancy	Positive discrepancy	Negative discrepancy
Baseline	65%*	25%	10%
12 months	73%*	23%	4%

Conclusion: PGA-MDGA discrepancy rate decreases over time but the pattern remains the same in early RA. Pain and SJC significantly influence PGA-MDGA discrepancy at baseline and this persists after one year when the disease is better controlled. Although previous studies have emphasized the pain score as a major factor affecting the PGA-MDGA discrepancy; we have also demonstrated a significant influence of the SJC.

Disclosure:

P. Akhavan, None; V. P. Bykerk,

Amgen, Pfizer, Roche, BMS, UCB, Janssen Biotech and Abbott,

J. Xiong,
None;

J. E. Pope,
None;

B. Haraoui,
None;

J. C. Thorne,
None;

G. Boire,
None;

C. A. Hitchon,
None;

D. Tin,
None;

E. Keystone,
None;

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