Sources of discrepancy in patient and physician global assessments of RA disease activity

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J Rheumatol. 2004 Jul;31(7):1293-6.

Sources of discrepancy in patient and physician global assessments of

rheumatoid arthritis disease activity.

Nicolau G, Yogui MM, Vallochi TL, Gianini RJ, Laurindo IM, Novaes GS.

Rheumatology Division, Sorocaba Hospital, and Department of Medicine,

School of Medicine at the Catholic University of Sao o, Sao o,

Brazil.

OBJECTIVE: To investigate discrepancy in the perception of rheumatoid

arthritis (RA) disease activity between patient and physician, and its

possible sources. METHODS: Eighty patients with RA rated their level of

disease activity on a visual analog scale (VAS). Physician global

assessment (MDGA) of disease activity was performed blinded to the

patient evaluation except for the results of laboratory tests. A

discrepancy score (DS) was calculated by subtracting MDGA from patient

global assessment (PTGA), leading to definition of 3 groups of patients:

(1) no discrepancy when PTGA and MDGA were within 1.0 or 3.0 cm of each

other; (2) negative discrepancy when PTGA was under-rated relative to

the physician; and (3) positive discrepancy when PTGA was over-rated

relative to the physician. Age, sex, disease duration, education,

income, residence area, employment, use of antirheumatic drugs,

comorbidity, pain score, Health Assessment Questionnaire (HAQ) rating,

tender (TJC) and swollen (SJC) joint count, and Disease Activity Score

(DAS28) were recorded. RESULTS: Negative discrepancy was found in 27.5%

(VAS 1 cm) and 8.7% (VAS 3 cm) of patients, positive discrepancy in

43.7% (VAS 1 cm) and 23.7% (VAS 3 cm), and no discrepancy in 28.7% (VAS

1 cm) and 67.5% (VAS 3 cm). Patients were predominantly older (mean age

near 50 yrs), female, with long disease duration and low income. The

negative discrepancy group had a lower level of education and higher

C-reactive protein (p < 0.05). The positive discrepancy group presented

a higher pain score, HAQ score, and TJC (p < 0.0001). The no-discrepancy

group had lower SJC (p < 0.05).

CONCLUSION: Our results indicate that for disease activity in patients

with RA assessed on pain score, HAQ, and TJC, the only important feature

that determined perception of their RA disease activity was education.

PMID: 15229946

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