Risk Factors for Persistent Discordance in Global Assessment of Rheumatoid Arthritis (RA) Disease Activity between RA Patients and Their Physicians: Analysis Based on a Nationwide RA Database (2011 to 2016)

Tetsuji Sawada¹, Susumu Nishiyama², Mayu Tago³, Koichiro Tahara³, Eri Kato¹, Hiroaki Mori³, Haeru Hayashi³, Toshihiro Matsui⁴, Jinju Nishino⁵ and Shigeto Tohma⁶, ¹Rheumatology, Tokyo Medical University, Shinjuku Tokyo, Japan, ²Rheumatic Disease Center, Kurashiki Medical Center, Okayama, Japan, ³Rheumatology, Tokyo Medical University, Tokyo, Japan, ⁴National Hospital Organization Sagamihara l Hospital, Clinical Research Center for Allergy and Rheumatology, Kanagawa, Japan, ⁵Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan, ⁶National Hospital Organization Tokyo National Hospital, Kiyose, Japan

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: patient-reported outcome measures and rheumatoid arthritis (RA)

Session Information

Date: Tuesday, October 23, 2018

Title: Patient Outcomes, Preferences, and Attitudes Poster II: Patient Perspectives

Session Type: ACR Poster Session C

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

Background/Purpose: Discordance between patient global assessment (PGA) and physician global assessment (PhGA) of RA disease activity may be problematic in clinical practice. Previous studies, including ours (Tago, Int J Rheum Dis, 2018), have shown that PGA-PhGA discordance is most strongly associated with pain, followed by functional impairment. The aim of the present study was to investigate the factors responsible for 5-year persistence of PGA-PhGA discordance using a nationwide RA database in Japan (NinJa).

Methods: Positive discordance and concordance were defined as PGA minus PhGA (PGA–PhGA) ≥3 cm and between -3 cm and 3 cm, respectively. RA patients whose 10-cm visual analog scale (VAS) data were available and who were registered in both NinJa 2011 and NinJa 2016 (n=4484) were investigated for the association of positive PGA–PhGA discordance in 2016 with clinical manifestations observed in 2011, including age, sex, age at RA onset, disease duration, pain VAS, tender joint counts (TJC), swollen joint counts (SJC), modified Health Assessment Questionnaire (mHAQ), stage, class, disease activity score in 28 joints-C-reactive protein level (DAS28-CRP), and PGA–PhGA discordance status.

Results: The mean PGA-PhGA was significantly higher in 2016 (1.14 ± 1.96) than in 2011 (1.03 ± 1.80) (p<0.01). On reviewing the discordance status in 2011, we found that the mean PGA-PhGA of RA patients who had been classified as showing positive discordance was 2.13 ± 2.13 in 2016, which was significantly higher than those classified as concordance in 2011 (1.12 ± 1.74) (p<0.01). Categorical variable-based analysis also demonstrated that 41.2% of RA patients in the positive discordance group in 2011 remained in the same group in 2016, while only 13.1% in the concordance group shifted to the positive discordance group in 2016; this difference was significant (p<0.01). Stepwise multivariate logistic regression analysis identified high mHAQ values, pain VAS, age, and positive discordance status as significant risk factors for the shift into positive discordance 5 years later (Table 1).

Conclusion: We have demonstrated that PGA-PhGA discordance expanded significantly over the 5-year period, and that this positive discordance can be persistent. Functional impairment, pain, existing discordance, and age are risk factors for persistent discordance. Therefore, RA care providers should focus on ameliorating functional impairment and alleviating pain to circumvent the development of PGA-PhGA discordance.

Table 1 Univariate (unadjusted) and stepwise multivariate (adjusted) logistic regression analysis of predictors of discordance 5 years later regarding PGA-PhGA discordance.

	Unadjusted OR	p-value	Adjusted OR	p-value
Age	1.03 [1.03-1.04]	<0.01	1.02 [1.02-1.03]	<0.01
Female	1.21 [0.98-1.51]	0.08	–	–
Disease duration	1.03 [1.02-1.04]	<0.01	–	–
Stage III-IV	1.62 [1.39-1.90]	<0.01	–	–
Class 3-4	2.08 [1.71-2.52]	<0.01	–	–
Pain VAS	1.33 [1.28-1.37]	<0.01	1.20 [1.13-1.26]	<0.01
TJC	1.03 [1.02-1.05]	<0.01	–	–
SJC	1.01 [0.98-1.03]	0.54	–	–
DAS28-CRP	1.36 [1.27-1.46]	<0.01	0.80 [0.72-0.90]	<0.01
mHAQ	2.54 [2.25-2.88]	<0.01	1.65 [1.41-1.92]	<0.01
PGA-PhGA	1.48 [1.42-1.55]	<0.01	1.25 [1.19-1.32]	<0.01

* OR, Odds ratio.

Disclosure: T. Sawada, None; S. Nishiyama, None; M. Tago, None; K. Tahara, None; E. Kato, None; H. Mori, None; H. Hayashi, None; T. Matsui, None; J. Nishino, None; S. Tohma, None.

To cite this abstract in AMA style:

Sawada T, Nishiyama S, Tago M, Tahara K, Kato E, Mori H, Hayashi H, Matsui T, Nishino J, Tohma S. Risk Factors for Persistent Discordance in Global Assessment of Rheumatoid Arthritis (RA) Disease Activity between RA Patients and Their Physicians: Analysis Based on a Nationwide RA Database (2011 to 2016) [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/risk-factors-for-persistent-discordance-in-global-assessment-of-rheumatoid-arthritis-ra-disease-activity-between-ra-patients-and-their-physicians-analysis-based-on-a-nationwide-ra-database-2011-to/. Accessed .

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