Background/Purpose: Discordance between patient and physician global estimates has been described in many rheumatic diseases, including rheumatoid arthritis (RA)¹, and has been associated with decreased work productivity², greater radiological joint destruction and functional impairment³, and a lower likelihood to be in remission⁴. The objective of this study was to compare the level of discordance according to self-reported race/ethnicity, and to estimate the level of discordance in patients who met and did not meet criteria for concomitant fibromyalgia (FM) by a FM Assessment Screening Tool (FAST3-P).

Methods: At one site, patients complete a multidimensional health assessment questionnaire/routine assessment of patient index data (MDHAQ/RAPID3) (0-30) as part of routine care, which includes 0-10 scores for physical function, and 0-10 visual analogue scales (VAS) for pain, patient global estimate (PATGL), and fatigue, as well as a 0-60 symptom checklist, and a 0-48 RADAI self-report painful joint count. FAST3-P is a cumulative index based on a 0–3 sum of 1 point each for pain VAS≥6, RADAI self-report joint count≥16, and symptom checklist≥16 (positive screen for FM≥2). The treating rheumatologist completes a RheuMetric checklist including a physician global (DOCGL) and 3 VAS for inflammation (DOCINF), damage (DOCDAM) and distress (DOCSTR). Patients with primary diagnoses of RA (ICD codes) were classified into one of 3 groups based on the difference between DOCGL and PATGL: concordant group (PATGL-DOCGL within ±2/10), negative discordance (DOCGL-PATGL≥2/10), and positive discordance (PATGL-DOCGL≥2/10). Values are reported as medians (standard deviation) and percentages. Comparisons according to self-reported ethnicity groups were performed using ANOVA or Chi².

Results: The study included 260 RA patients: 38% Whites, 25% Black, 23% Hispanics, and 14% others. Age and sex were similar in the 4 groups. Education level was highest in “others,” (primarily Asian), followed by White, Black and Hispanic patients. Hispanic patients had poorer scores for pain, physical function, fatigue, and RADAI self-reported compared with other groups (p< 0.001) (Table). A higher percentage of Black and Hispanic patients screened positive for FM according to FAST3-P. Higher scores for PATGL with similar scores for DOCGL lead to higher rate of positive PATGL >DOCGL discordance in Hispanic patients versus others. The difference between PATGL-DOCGL was higher in patients with concomitant FM for each group except for “others” (Figure).

Conclusion: Hispanic patients with RA have poor scores on most MDHAQ self-reported measures compared with non-Hispanic Whites or Black despite similar physician assessments, leading to higher positive discordance rates. Concomitant FM in all RA patients may be an important contributor to discordance between DOCGL and PATGL, recognition of which could help improve the quality of care.

References: 1. Arthritis Care Res (Hoboken). 2014;66(6):934-42. 2. Arthritis Res Ther 2016, 18(1):114. 3. J Rheumatol 2014, 41(6):1061-1066. 4. Ann Rheum Dis. 2016;76(4):708-11.

Table_Discordance

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/hispanic-patients-with-rheumatoid-arthritis-have-greater-discordance-between-patient-and-physician-global-estimates-than-other-ethnic-groups-explained-largely-by-fibromyalgia-fm-according-to-a-fm-a/