ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 118

Rates and Determinants of Persistent Patient-Physician Discordance in Global Assessment of Disease Activity in Latinos with Rheumatoid Arthritis in the United States

George A. Karpouzas1, Elizabeth Hernandez2, Chelsie Cost2 and Sarah Ormseth2, 1Division of Rheumatology, Harbor-UCLA Medical Center, Torrance, CA, 2Rheumatology, Harbor-UCLA Medical Center, Torrance, CA

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords:

Session Information

Date: Sunday, November 13, 2016

Title: Healthcare Disparities in Rheumatology - Poster I

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Patients and physicians often differ in their assessments of Rheumatoid arthritis (RA) activity [PGA and EGA respectively]. Such differences may jeopardize attainment of remission. We evaluated proportions of patients with persistently discordant and concordant evaluations (PGA-EGA) over time, and determinants thereof.

Methods: We evaluated 271 Latinos with established RA at baseline (T1) and 12 months later (T2). Tender (TJC) and swollen (SJC) joint counts, pain [visual analogue scale (VAS)], fatigue (VAS), disability [Health Assessment Questionnaire-HAQ-DI], and depression assessments [Patient Health Questionnaire-9 (PHQ9)] were collected. PGA and EGA were captured on 0-10cm VAS; persistent discordance was defined as (PGA-EGA)>=3cm at both time points. Persistently concordant (pC) subjects had -3<PGA-EGA<3, persistently positive discordant (pPD) had (PGA-EGA) >=3, while persistently negative discordant (pND) ones had (PGA-EGA) <=-3. Mutlinomial forward stepwise logistic regression analysis identified independent predictors of individual group membership compared to the pC group (referent).

Results: We observed pC in 94 (34.7%) subjects, pPD in 51 (18.8%), and pND in 4 (1.5%), [figure 1a]. Another 60 (22.2%) changed from baseline concordant to discordant [50 (18.5%) PD, and 10 (3.7%) ND], 43 (15.8%) from baseline PD to either C [41 (15.1%)] or ND [2 (0.7%)], and an additional 19 (7%) patients shifted from baseline ND to either C [15 (5.5%)], or PD [4 (1.5%)]. The magnitude of (PGA-EGA) difference in the four largest groups is shown in figure 1b. Patients in the pPD group were more likely to have higher T1 disability, pain, and depression scores, lower baseline TJC and SJC, and less likely to have improvement in pain compared to those in the pC (all p=<0.007, table 1).

Conclusion: Persistently positively discordant PGA-EGA assessments are common in Latinos with RA (18.8%), potentially jeopardizing remission attainment. Determinants of this state do not include markers of disease activity but rather, higher baseline functional disability, depression scores, pain, and lack of improvement in pain.

Table 1: Independent predictors of unique group membership compared to the persistently Concordant (pC) group as referent

State parameters B Std Error p OR 95% CI

Persistent Positive Discordance (pPD)

Intercept -6.276 0.946 0.000
HAQ-DI-T1 1.521 0.450 0.001 4.576 1.894- 11.056
PHQ9-T1 0.154 0.057 0.007 1.166 1.043- 1.303
TJC-T1 -0.526 0.131 0.000 0.591 0.457- 0.765
TJC-change 0.287 0.107 0.007 1.332 1.081- 1.642
SJC-change 0.659 0.204 0.001 1.933 1.297- 2.880
Pain-change -1.013 0.180 0.000 0.363 0.255- 0.517
SJC-T1 -0.983 0.228 0.000 0.374 0.239- 0.585
Pain-T1 1.310 0.208 0.000 3.706 2.467- 5.566

Concordant to Positive Discordant (C¨PD)

Intercept -2.686 .524 0.000
HAQ-DI-T1 0.544 0.396 0.170 1.723 0.793- 3.744
PHQ9-T1 0.146 0.056 0.009 1.158 1.038- 1.291
TJC-T1 -0.475 0.132 0.000 0.622 0.480- 0.806
TJC-change 0.431 0.128 0.001 1.538 1.198- 1.975
SJC-change 0.714 0.184 0.000 2.043 1.425- 2.927
Pain-change -1.034 0.164 0.000 0.355 0.257- 0.491
SJC-T1 -0.607 0.189 0.001 0.545 0.377- 0.789
Pain-T1 0.670 0.164 0.000 1.955 1.418- 2.696

Positive Discordant to Concordant (PD¨C)

Intercept -2.981 0.567 0.000
HAQ-DI-T1 1.199 0.418 0.004 3.318 1.463- 7.522
PHQ9-T1 0.087 0.056 0.117 1.091 0.978- 1.217
TJC-T1 -0.193 0.135 0.154 0.825 0.633- 1.075
TJC-change -0.085 0.079 0.283 0.919 0.787- 1.072
SJC-change -0.111 0.109 0.311 0.895 0.722- 1.109
Pain-change -0.205 0.163 0.207 0.815 0.592- 1.120
SJC-T1 -0.687 0.206 0.001 0.503 0.336- 0.753
Pain-T1 0.462 0.174 0.008 1.588 1.129- 2.234
Disclosure: G. A. Karpouzas, None; E. Hernandez, None; C. Cost, None; S. Ormseth, None.

To cite this abstract in AMA style:

Karpouzas GA, Hernandez E, Cost C, Ormseth S. Rates and Determinants of Persistent Patient-Physician Discordance in Global Assessment of Disease Activity in Latinos with Rheumatoid Arthritis in the United States [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/rates-and-determinants-of-persistent-patient-physician-discordance-in-global-assessment-of-disease-activity-in-latinos-with-rheumatoid-arthritis-in-the-united-states/. Accessed .

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