In:
International Journal of Rheumatic Diseases, Wiley, Vol. 21, No. 6 ( 2018-06), p. 1237-1245
Abstract:
The discordance between patient global assessment ( PGA ) and physician global assessment (Ph GA ) of rheumatoid arthritis ( RA ) disease activity may be problematic in clinical practice. The aim of this study was to identify determinants of this discordance using a nationwide RA database in Japan ( NinJa ) with special attention to large joint involvement. Methods We investigated 12 043 adults with RA and used a discordance cutoff of 3 cm. Large joint involvement was investigated using novel joint indices ( x , y , z ), where x and y were the indices for upper and lower joints, respectively, and z was for large joint predominance. Predictors of PGA ‐Ph GA discordance and determinants of PGA and Ph GA were analyzed by multivariate logistic and linear regression models, respectively. Results Multivariate logistic regression identified age, pain and high modified Health Assessment Questionnaire score as predictors of positive discordance ( PGA ≥ Ph GA ), whereas parameters of disease activity in RA (C‐reactive protein, x and y ), class 3–4 functional status, and z were found to predict against positive discordance. Linear regression analysis revealed that PGA was mainly determined by pain, whereas Ph GA was determined by various other factors. Conclusions RA care providers should focus on pain and functional disability to decrease PGA ‐Ph GA discordance. High disease activity and large joint involvement decreased PGA ‐Ph GA discordance, indicating that the number and distribution of affected joints influenced the perception of disease activity by patients with RA and their physicians.
Type of Medium:
Online Resource
ISSN:
1756-1841
,
1756-185X
DOI:
10.1111/apl.2018.21.issue-6
DOI:
10.1111/1756-185X.13281
Language:
English
Publisher:
Wiley
Publication Date:
2018
detail.hit.zdb_id:
2427877-4
Permalink