ObjectiveThis study was designed to evaluate the determinants of patient and physician global assessments (PtGA and MDGA, respectively) of disease activity, their discordance and change over 2 years in Hispanics with rheumatoid arthritis (RA). We further examined the impact of discordance and its persistence on health-related quality of life (HRQOL) and work productivity on final visit.MethodsWe studied 536 Hispanics with established RA from a single centre. PtGA and MDGA were measured annually on 10 cm visual analogue scales and discordance was defined as absolute difference between them ≥3 cm. Associations between predictors and outcomes of interest were evaluated using multivariable regression and analysis of covariance for cross-sectional and longitudinal data, respectively.ResultsIndependent predictors of baseline PtGA were pain, fatigue, depression, general health perceptions and tender joint count. MDGA was predicted by swollen joint count, tender joint count, erythrocyte sedimentation rate, fatigue and depression. Both PtGA and MDGA improved over time (all p<0.001). Discordance was observed in 43% at baseline, with fair stability over 2 years. Higher (worse) patient ratings were most prevalent; their presence at any time and increasing persistence predicted lower physical and mental HRQOL, decreased work productivity and more activity impairment at 2-year follow-up (all p<0.001).ConclusionsDeterminants of PtGA, MDGA and changes over 2 years were disparate in Hispanics with RA yielding significant discordance. Higher patient ratings at any time contributed to worse HRQOL, work productivity and activity impairment on final visit.
BackgroundPain represents the cardinal complaint in patients with rheumatoid arthritis (RA). It may reflect inflammation, structural damage, or aberrant processing and regulatory mechanisms.ObjectivesWe evaluated whether changes in pain reflect inflammatory burden variation or non-inflammatory factors in Latinos with established RA in the United States (US).MethodsWe evaluated 271 patients from a single academic center with complete data in parameters of interest on 2 visits, 12 months apart. Demographics, serologies, swollen and tender joint assessments, sedimentation rate, fatigue-VAS (visual analogue scale), pain-VAS, depression assessment (Patient Health Questionnaire-PHQ9), functional disability (Health Assessment Questionnaire, HAQ-DI), presence of erosions and irreversible articular damage (IAD, including subluxation, fusion, arthrodesis, or prosthesis) were recorded. Principal components factor analysis with varimax rotation determined latent variables of symptom change. Multinomial logistic regression modeling with forward stepwise entry determined parameters associated with clinically meaningful change in pain compared to no changeResultsTwo factors met acceptance criteria (Eigenvalues ≥1) with values of 2.57 and 1.31 respectively (Table 1). Following rotation, factor 1 loadings comprised change in fatigue, pain, depression scores, and functional disability, representing non-inflammatory factors. Conversely, factor 2 encompassed changes in tender and swollen joints and ESR, representing inflammation. Clinically relevant improvement in pain significantly correlated with respective improvements in fatigue, depression, functional disability and tender joints (Table 2); worsening pain was negatively associated with change in disability or fatigue.ConclusionsIn Latinos with established RA, change in pain reporting reflects alterations in non-inflammatory parameters such as fatigue, depression and functional disability rather than inflammation. Active screening and consideration of those factors may inform therapeutic interventions, balance patient and physician expectations, and optimize patient satisfaction and clinical outcomes.Disclosure of InterestNone declared
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