title: Learning from discordance in patient and physician global assessments of systemic lupus erythematosus disease activity.
abstract: OBJECTIVE
  Differences have been described between patient and physician assessments of well being in several chronic illnesses, and these differences may affect outcome. Disagreement may lead to dissatisfaction and to behaviors with dangerous consequences. We describe and identify predictors of patient-physician differences on ratings of disease activity in systemic lupus erythematosus (SLE).
  
  
  METHODS
  Data collected on 154 patients included age, education, disease duration, and patient and physician global assessments of lupus activity on a 10 cm visual analog scale (VAS), the Health Assessment Questionnaire (HAQ), the Medical Outcome Study Short-Form 36 (SF-36), the Systemic Lupus Disease Activity Index (SLEDAI), the Systemic Lupus Activity Measure (SLAM-R), and the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). Multiple linear regression models were performed using patient VAS scores, physician VAS scores, and patient minus physician VAS scores as the dependent variables, and age, disease duration, selected SF-36 and SLAM-R subscales, and SDI as independent variables.
  
  
  RESULTS
  Patients were 90% female and 80% Caucasian, with a mean education of 13 +/- 2.8 years and a mean age of 43.1 +/- 13.6 years. The overall mean disease duration was 10.5 +/- 7.8 years. Physicians overscored patients by 2.5 cm in 6% of the cases and patients overscored physicians in 16% of the cases. The best multivariate model to predict overall differences included SF-36 mental health and SLAM-R kidney scores.
  
  
  CONCLUSIONS
  Patient-physician differences may result from a divergence in focus. Patients score lupus activity based on their psychological status, while physicians rely more heavily on the physical effect of the disease.
authors.affiliation: Division of Rheumatology, Montreal General Hospital, McGill University, Quebec, Canada.
authors.forename: C
authors.initials: C
authors.lastname: Neville
authors.forename: A E
authors.initials: AE
authors.lastname: Clarke
authors.forename: L
authors.initials: L
authors.lastname: Joseph
authors.forename: P
authors.initials: P
authors.lastname: Belisle
authors.forename: D
authors.initials: D
authors.lastname: Ferland
authors.forename: P R
authors.initials: PR
authors.lastname: Fortin
mesh_terms: D000328:Adult; D005260:Female; D006304:Health Status; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000503:physiopathology* / Q000523:psychology; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D010147:Pain Measurement; D010820:Physicians; D012044:Regression Analysis; D012647:Self-Assessment; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires