title: Determinants of Patient-Physician Discordance in Global Assessment in Psoriatic Arthritis: A Multicenter European Study.
abstract: Patient-physician discordance in global assessment of disease activity concerns one-third of patients, but what does it reflect? We aimed to assess patient-physician discordance in psoriatic arthritis (PsA) and patient-reported domains of health (physical and psychological) associated with discordance.
  
  
  
  We analyzed the PsAID (Psoriatic Arthritis Impact of Disease), a cross-sectional, multicenter European study of patients with PsA according to expert opinion. Patient global assessment (PGA) and physician global assessment (PhGA) were rated on a 0-10 numeric rating scale. Discordance was defined as the difference (PGA-PhGA) and as the absolute difference |PGA-PhGA| ≥3 points. Determinants of PGA-PhGA were assessed by a stepwise multivariate linear regression among 12 physical and psychological aspects of impact: pain, skin problems, fatigue, ability to work/leisure, functional incapacity, feeling of discomfort, sleep disturbance, anxiety/fear, coping, embarrassment/shame, social participation, and depressive affects.
  
  
  
  In 460 patients (mean ± SD age 50.6 ± 12.9 years, 52.2% female, mean ± SD disease duration 9.5 ± 9.5 years, mean ± SD Disease Activity Index for Psoriatic Arthritis score 30.8 ± 32.4, and 40.4% undergoing treatment with biologic agents), the mean ± SD PGA was higher than the mean PhGA, with a mean absolute difference of 1.9 ± 1.8 points. Discordance defined by |PGA-PhGA| ≥3 of 10 concerned 134 patients (29.1%), and 115 patients (85.8% of the patients with discordance) had PGA>PhGA. Higher fatigue (β = 0.14), lower self-perceived coping (β = 0.23), and impaired social participation (β = 0.16) were independently associated with a higher difference (PGA-PhGA).
  
  
  
  Discordance concerned 29.1% of these patient/physician dyads, mainly by PGA>PhGA. Factors associated with discordance were psychological rather than physical domains of health. Discordance was more frequent in patients in remission, indicating more work is needed on the patient perspective regarding disease activity.
authors.affiliation: Sorbonne Universités, UPMC University Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS), AP-HP, Hôpital Pitié Salpêtrière, Paris, France.
authors.forename: Carole
authors.initials: C
authors.lastname: Desthieux
authors.affiliation: Sorbonne Universités, UPMC University Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS), AP-HP, Hôpital Pitié Salpêtrière, Paris, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Granger
authors.affiliation: University of Medicine and Pharmacy Carol Davila and St Maria Hospital, Bucharest, Romania.
authors.forename: Andra Rodica
authors.initials: AR
authors.lastname: Balanescu
authors.affiliation: National Institute of Rheumatology and Physiotherapy, Budapest, Hungary.
authors.forename: Peter
authors.initials: P
authors.lastname: Balint
authors.affiliation: Ruhrgebiet, Herne and Ruhr-Universität Bochum, Herne, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Braun
authors.affiliation: Hospital Clínic and IDIBAPS, Barcelona, Spain.
authors.forename: Juan D
authors.initials: JD
authors.lastname: Canete
authors.affiliation: Østfold University College, Halden, and Regional Research Support, Oslo University Hospital, Oslo, Norway.
authors.forename: Turid
authors.initials: T
authors.lastname: Heiberg
authors.affiliation: University of Leeds, Leeds, UK.
authors.forename: Philip S
authors.initials: PS
authors.lastname: Helliwell
authors.affiliation: Hacettepe University, Ankara, Turkey.
authors.forename: Umut
authors.initials: U
authors.lastname: Kalyoncu
authors.affiliation: Diakonhjemmet Hospital, Oslo, Norway.
authors.forename: Tore K
authors.initials: TK
authors.lastname: Kvien
authors.affiliation: Ruhrgebiet, Herne and Ruhr-Universität Bochum, Herne, Germany.
authors.forename: Uta
authors.initials: U
authors.lastname: Kiltz
authors.affiliation: National Institute of Rheumatology and Physiotherapy, Budapest, Hungary.
authors.forename: Dora
authors.initials: D
authors.lastname: Niedermayer
authors.affiliation: Tallinn Central Hospital, Tallinn, Estonia.
authors.forename: Kati
authors.initials: K
authors.lastname: Otsa
authors.affiliation: Sapienza Università di Roma, Rome, Italy.
authors.forename: Rossana
authors.initials: R
authors.lastname: Scrivo
authors.affiliation: III Medical University of Vienna, Vienna, Austria.
authors.forename: Josef
authors.initials: J
authors.lastname: Smolen
authors.affiliation: III Medical University of Vienna, Vienna, Austria.
authors.forename: Tanja A
authors.initials: TA
authors.lastname: Stamm
authors.affiliation: Dublin Academic Medical Centre and St Vincent's University Hospital, Dublin, Ireland.
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Veale
authors.affiliation: University Hospitals Leuven, Leuven, Belgium.
authors.forename: Kurt
authors.initials: K
authors.lastname: de Vlam
authors.affiliation: Patient Research Partner, People with Arthritis/Rheumatism in Europe, Zurich, Switzerland.
authors.forename: Maarten
authors.initials: M
authors.lastname: de Wit
authors.affiliation: Sorbonne Universités, UPMC University Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS), AP-HP, Hôpital Pitié Salpêtrière, Paris, France.
authors.forename: Laure
authors.initials: L
authors.lastname: Gossec
mesh_terms: D000328:Adult; D015535:Arthritis, Psoriatic / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D057189:Checklist; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005060:Europe; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006304:Health Status; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D015588:Observer Variation; D010361:Patients / Q000523:psychology*; D010819:Physician's Role; D011237:Predictive Value of Tests; D011379:Prognosis; D012074:Remission Induction; D015203:Reproducibility of Results; D057566:Self Report; D012720:Severity of Illness Index