title: Determinants of discordance in patients' and physicians' rating of rheumatoid arthritis disease activity.
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.
  
  
  CONCLUSIONS
  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.
authors: University of Arkansas for Medical Sciences, Little Rock, AR, USA. nakhan@uams.edu
authors: Nasim A
authors: NA
authors: Khan
authors: Horace J
authors: HJ
authors: Spencer
authors: Esam
authors: E
authors: Abda
authors: Amita
authors: A
authors: Aggarwal
authors: Rieke
authors: R
authors: Alten
authors: Codrina
authors: C
authors: Ancuta
authors: Daina
authors: D
authors: Andersone
authors: Martin
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authors: Bergman
authors: Jurgen
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authors: Craig-Muller
authors: Jacqueline
authors: J
authors: Detert
authors: Lia
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authors: Georgescu
authors: Laure
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authors: Gossec
authors: Hisham
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authors: Hamoud
authors: Johannes W G
authors: JW
authors: Jacobs
authors: Ieda Maria Magalhaes
authors: IM
authors: Laurindo
authors: Maria
authors: M
authors: Majdan
authors: Antonio
authors: A
authors: Naranjo
authors: Sapan
authors: S
authors: Pandya
authors: Christof
authors: C
authors: Pohl
authors: Georg
authors: G
authors: Schett
authors: Zahraa I
authors: ZI
authors: Selim
authors: Sergio
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authors: Toloza
authors: Hisahi
authors: H
authors: Yamanaka
authors: Tuulikki
authors: T
authors: Sokka
mesh_terms: D018771:Arthralgia / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D005221:Fatigue / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010817:Physician-Patient Relations; D015203:Reproducibility of Results; D012647:Self-Assessment; D012720:Severity of Illness Index