Clinical variables, including novel joint index, associated with future patient‐physician discordance in global assessment of rheumatoid arthritis (RA) disease activity based on a large RA database in Japan

Abstract

Background: Discordance between patient global assessment (PGA) and physician global assessment (PhGA) of rheumatoid arthritis (RA) disease activity is mainly determined by pain and functional disabilities. This study aimed to investigate the shift in PGA-PhGA discordance and the variables associated with future positive discordance (PGA > PhGA) based on the NinJa database in Japan. Methods:We examined 7557 adults with RA registered in both NinJa 2014 and 2018, with a discordance cutoff of 3 on a 10-cm scale. The affected joint distribution was investigated using the joint indices x, y, and z, which were calculated as indices for the upper joint, lower joint, and large joint involvement, respectively. The variables in NinJa 2014 that were associated with positive discordance in NinJa 2018 were examined using binary stepwise logistic regression analysis.Results: Due to the small number of patients with RA categorized as having negative discordance (PGA < PhGA), we focused on patients with RA categorized as having either concordance or positive discordance. Logistic regression analysis revealed that positive discordance in NinJa 2018 was associated with age, pain, modified Health Assessment Questionnaire (mHAQ) score, corticosteroid use, and existent positive discordance and was inversely associated with C-reactive protein (CRP) and x at baseline (NinJa 2014). The same findings were observed when patients with RA were divided based on the discordance status at baseline. Persistence (positive discordance to positive discordance) was associated with pain and mHAQ scores but inversely associated with CRP.

Prevalence and Factors Associated With Patient–Clinician Discordance Among Patients With Rheumatoid Arthritis Initiating Advanced Therapy

“…In our data, there was an association of anxiety and depression with index visit discordance in unadjusted analyses, though this was attenuated in multivariable analyses. Although a few previous observational studies have evaluated how patient-clinician discordance evolves over time (2,7,10,11), to our knowledge only two examined factors associated with persistent discordance. In the aforementioned singlecenter study among US Hispanic patients, patients with persistent positive discordance over 2 years were more likely to have fibromyalgia and irreversible articular damage (10).…”

“…Furthermore, persistent discordance was associated with greater activity impairment and loss of employment and/or work productivity. In a study of Japanese patients with RA, persistent discordance was associated with pain and modified health assessment questionnaire (MHAQ) scores ( 11 ). A longitudinal study that did not assess persistent discordance also found that discordance was associated with progressive joint destruction and functional impairment ( 7 ).…”

“…Such advances could consequently lead to improved treatment and increased quality of life. Currently, our knowledge of the frequency and correlates of discordance among real‐world patients with RA is limited by a lack of data on persistent discordance because few longitudinal observational studies exist ( 7 , 10 , 11 ).…”