Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: Discrepancy between patient (PGA) and physician (MDGA) global assessments in Rheumatoid Arthritis (RA) can adversely affect therapeutic decisions. The pattern of PGA and MDGA, factors influencing each and the discrepancy between the two may be different in patients with established disease compare to patients with early disease. The objective of this study was to assess the pattern of PGA-MDGA discrepancy in early and established RA and to identify predictors of this discrepancy in the two patient populations.
Methods: Patients with RA were recruited from the Ontario Best Practice Initiative (OBRI), a clinical registry of RA patients followed in routine care. PGA and MDGA were scored from 0-100. 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)). The rate of discrepancy was determined in patients with disease duration of less than or equal to 12 months (early RA) and disease duration of greater than 5 years (established RA) at baseline. Linear regression analysis was used to evaluate factors associated with MDGA, PGA and the PGA-MDGA discrepancy when adjusted for potential confounders including patient demographics, ESR, swollen joint count (SJC), tender joint count (TJC), pain, RF and anti-CCP and joint damage in both early and established disease.
Results: : 439 early and 737 established RA patients were analyzed with the mean age of 57.0 and 59.0 years and DAS28 of 4.7 and 4.5 respectively. Mean PGA was 50.0 and 53.0 and MDGA was 48.0 and 43.0 in early and established groups respectively. A meaningful PGA-MDG discrepancy was found in182 (41%) early (101 positive and 81 negative) and 309 (42%) established (229 positive and 80 negative) RA. Regression analysis showed that there was a significant association between MDGA and pain, TJC, SJC and ESR at baseline in both groups and pain score was the only predictor of PGA. PGA-MDGA discrepancy was associated with pain (p<.0001), TJC (p=0.0014), SJC (p=0.004) and ESR (p=0.01) in early RA and was associated with pain (p<.0001), TJC (p=0.002), SJC(p<.0001) and age (p=0.05) in patients with established disease (Table). In both groups higher pain score, SJC or TJC would increase the discrepancy. Higher pain score would increase the positive discrepancy (PGA>MDGA) whereas SJC, TJC and ESR (only in early RA) would increase the negative discrepancy (MDGA>PGA).
Conclusion: PGA-MDGA discrepancy exists in a significant portion of RA patients irrespective of their disease duration. Pain score and active joints are the main clinical factors affecting this discrepancy in patients with either early or established disease.
Table- Multivariate analysis assessing predictors of PGA- MDGA discrepancy in patient with early and established RA
|
Predictors |
Early RA |
Established RA |
||
|
β |
p-value |
β |
p-value |
|
|
Age |
0.07 |
0.51 |
0.17 |
0.05 |
|
Female |
-2.83 |
0.38 |
-2.75 |
0.25 |
|
TJC |
-0.90 |
0.001 |
-0.63 |
0.002 |
|
SJC |
-1.00 |
0.004 |
-1.85 |
<0.0001 |
|
ESR |
-0.15 |
0.01 |
-0.05 |
0.23 |
|
Pain score |
6.68 |
<.0001 |
6.03 |
<.0001 |
|
RF positive |
-0.10 |
0.29 |
-0.03 |
0.35 |
|
Anti-CCP positive |
-0.03 |
0.33 |
-0.02 |
0.40 |
|
Joint damage |
-2.26 |
0.33 |
-0.03 |
0.98 |
|
Education |
0.89 |
0.68 |
2.21 |
0.17 |
Disclosure:
P. Akhavan,
None;
B. Jacob,
OBRI,
2;
E. C. Keystone,
None;
X. Li,
None;
J. C. Thorne,
None;
C. Bombardier,
OBRI,
2.
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