Session Type: Abstract Submissions (ACR)
Background/Purpose: The Physician Global Assessment represents the average assessment of a patient’s disease activity based on physical examination and laboratory data while the Patient Global Assessment reflects the patient’s perceived overall health and disease activity. The discordance between the physician and patient assessments has been previously observed. This current study investigates the influence of the specific question being asked in the questionnaire on the concordance between physician and patient assessments. This study will analyze the correlation between patient and physician assessments of disease activity in a longitudinal cohort.
Methods: Data was collected on a convenience sample of 43 patients with SLE enrolled in a subset of the NYU cohort. Each patient completed a questionnaire which included a Lupus Activity Patient Global Assessment (LA PtGA) on a visual analog scale (0-100) focusing on the patient’s perceived SLE disease activity by asking the patient to indicate how active the patient thought her lupus was. Additionally, each patient completed the Modified Health Assessment Questionnaire (MDHAQ), utilized in routine clinical care. This questionnaire contains a PtGA on a numerical rating scale (0-10) that specifically asks patients to evaluate how their illness and health conditions affect them. These two PtGAs values were compared to the physician global assessment (PGA) on a numerical rating scale (0-3) and SELENA-SLEDAI scores. Each patient had multiple visits included in the analysis. The level of correlation was determined by the Spearman rank order correlations.
Results: 43 patients seen on average of 2.3 visits were included in the study. The mean age was 42.1 years, 95% females, 34% were Caucasian, 24% Black, 30% Hispanic, 11% Asian, disease duration was 13.02 + 9.01 years, and 74% of patients had 3rdparty insurance. The mean SELENA-SLEDAI score (3.13±2.94), PGA (1.07±0.75), LA PtGA (25.68±24.66), and MDHAQ PtGA (3.04±2.80) reflect mild SLE activity. The correlation between PGA and SELENA-SLEDAI was 0.69 (p<0.01). The correlation between PGA and LA PtGA was 0.32 (p<0.01). In contrast, the correlation between the PGA and the MDHAQ PtGA was only 0.13 (p=0.18). The two PtGAs correlated well with each other with r= 0.58 (p<0.01).
Conclusion: As expected, the correlations between PGA and SLEDAI score as well as between LA PtGA and MDHAQ PtGA were high. The strength of association between LA PtGA and the physician measure were more modest. Given the absence of a statistically significant correlation between the MDHAQ PtGA and PGA, the data emphasizes the importance of the content of the questions being asked on patient instruments to ensure patients are evaluating lupus specific disease activity rather than overall health conditions. The latter may be misleading since it is less specifically focused on lupus per se. Understanding all the factors that influence patients’ evaluation of their lupus disease activity is essential in creating an accurate SLE PtGA tool which can be used in clinical settings.
J. P. Buyon,
« Back to 2013 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/patients-perception-of-their-lupus-disease-activity-but-not-overall-health-correlates-with-physician-assessments/