Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Perception of RA Disease Activity by Patients and Physicians: Reasons for and Estimators of Discrepancies.
Studenic, Paul, S. Smolen, Josef, Aletaha, Daniel
In clinical practice, the perception of disease activity in rheumatoid arthritis (RA) often differs between physicians and patients. These discrepancies may impact the patient-physician relationship. It is not completely clear in what proportion of patients the perception is different, and why. We aimed to investigate this discordant perception in more detail.
We identified RA patients from an observational, prospective RA outpatient database, and obtained visual analogue scores (VAS) for global disease activity perception by the patients (PGA) and evaluators (EGA). Patients were divided into tertiles by PGA and by EGA, and the groups were then cross-tabulated. We explored the other RA core set variables in patient groups, formed according to concordant (tertile of PGA equivalent to tertile of EGA) or discordant tertiles (differing tertiles: PGA>EGA or EGA>PGA). For statistical comparisons, Mann-Whitney-U-Test was performed.
Of the 302 RA patients (81% women, 61% rheumatoid factor positive, mean disease duration: 10.1 years), 49.3% fell into concordant PGA and EGA tertiles; 25.5% were discordant with higher tertile by PGA, and 25.2% were discordant with higher tertile by EGA. Those falling into higher EGA than PGA tertiles, had significantly higher swollen joint counts (SJC), but lower pain scores, and lower HAQ-scores, suggesting that EGA is primarily influenced by SJC and PGA by pain.
Given the impact of swelling for EGA and pain for PGA, we calculated the SJC/TJC ratio as an estimate for this discrepancy, finding good correlation with the additional variable "EGA minus PGA" (r=0.399, p=0.0001, Spearman-rho) and association with the respective tertiles Figure. A SJC/TJC ratio of 0.60.7 appears associated with a balanced perception by patients and evaluators, irrespective of disease activity Figure.
White: concordant groups; black: group PGA>EGA; gray: group PGA<EGA
Figure 1. SJC/TJC ratio of PGA/EGA tertiled groups.
The evaluator's perception of disease activity is strongly driven by the SJC, while the patient's perception is driven by pain and functional disability. A SJC/TJC ratio of ~0.65 seems associated with a balanced perception. For the rheumatologist, a ratio of >1.0 may serve as an indicator for the need of more detailed explanation of treatment changes, while a ratio of <0.4 may indicate a need for more intensified pain management to better comply with the patient's perception.
To cite this abstract, please use the following information:
Studenic, Paul, S. Smolen, Josef, Aletaha, Daniel; Perception of RA Disease Activity by Patients and Physicians: Reasons for and Estimators of Discrepancies. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :79