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Title: Determinants of discordance in patients' and physicians' rating of rheumatoid arthritis disease activity
Authors: Khan, Nasim A.
Spencer, Horace J.
Abda, Esam
Aggarwal, Amita
Alten, Rieke
Ancuta, Codrina
Andersone, Daina
Bergman, Martin
Craig-Muller, Jurgen
Detert, Jacqueline
Georgescu, Lia
Gossec, Laure
Hamoud, Hisham
Jacobs, Johannes W.G.
Laurindo, Ieda Maria Magalhaes
Majdan, Maria
Naranjo, Antonio 
Pandya, Sapan
Pohl, Christof
Schett, Georg
Selim, Zahraa I.
Toloza, Sergio
Yamanaka, Hisahi
Sokka, Tuulikki
UNESCO Clasification: 32 Ciencias médicas
320509 Reumatología
Keywords: Rheumatoid arthritis
Quantitative Standard Monitoring of Patients
Issue Date: 2012
Journal: Arthritis and rheumatism 
Abstract: Objective To assess the determinants of patients' (PTGL) and physicians' (MDGL) global assessment of rheumatoid arthritis (RA) activity and factors associated with discordance among them. Methods A total of 7,028 patients in the Quantitative Standard Monitoring of Patients with RA study had PTGL and MDGL assessed at the same clinic visit on a 0–10-cm visual analog scale (VAS). Three patient groups were defined: concordant rating group (PTGL and MDGL within ±2 cm), higher patient rating group (PTGL exceeding MDGL by >2 cm), and lower patient rating group (PTGL less than MDGL by >2 cm). Multivariable regression analysis was used to identify determinants of PTGL and MDGL and their discordance. Results The mean ± SD VAS scores for PTGL and MDGL were 4.01 ± 2.70 and 2.91 ± 2.37, respectively. Pain was overwhelmingly the single most important determinant of PTGL, followed by fatigue. In contrast, MDGL was most influenced by swollen joint count (SJC), followed by erythrocyte sedimentation rate (ESR) and tender joint count (TJC). A total of 4,454 (63.4%), 2,106 (30%), and 468 (6.6%) patients were in the concordant, higher, and lower patient rating groups, respectively. Odds of higher patient rating increased with higher pain, fatigue, psychological distress, age, and morning stiffness, and decreased with higher SJC, TJC, and ESR. Lower patient rating odds increased with higher SJC, TJC, and ESR, and decreased with lower fatigue levels. Conclusion Nearly 36% of patients had discordance in RA activity assessment from their physicians. Sensitivity to the “disease experience” of patients, particularly pain and fatigue, is warranted for effective care of RA.
ISSN: 0004-3591
DOI: 10.1002/acr.20685
Source: Arthritis Care and Research[ISSN 0004-3591],v. 64(2), p. 206-214 (Febrero 2012)
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