Factors associated with patient‐physician discordance in a prospective cohort of patients with psoriatic arthritis: An Asian perspective

Abstract

Objectives To evaluate factors associated with patient‐physician discordance in a multiethnic Asian cohort of psoriatic arthritis (PsA) patients. Methods We used data from a prospective cohort of consecutive patients with PsA fulfilling the Classification Criteria for Psoriatic Arthritis, recruited from a single center in Singapore. Sociodemographic, clinical data and patient‐reported outcomes were collected using a standardized protocol at baseline, 4 months, 8 months, 1 year, 2 years and 5 years. patient‐physician discordance was defined as patient global assessment minus physician global assessment (PGA‐PhGA). We evaluated variables associated with patient‐physician discordance using generalized linear regression to control for within‐subject effect. Results One hundred and fortytwo patients (51.4% male, 66.2% Chinese, mean [SD] age and duration of illness 51.1 [13.8] years and 27.5 [98.3] months) were recruited at baseline. Paired results for PGA and PhGA were available for 291 visits with median (interquartile range) follow‐up time of 11.6 (17) months. In univariable analysis, duration of illness, fatigue, pain, tender and swollen joint count, dactylitis count, and health‐related quality of life (Short Form‐36) domains were significantly correlated with patient‐physician discordance. In multivariable analysis, age, fatigue level, pain score were positively associated with patient‐physician discordance, while swollen joint count and mental health were negatively associated with patient physician discordance. Conclusions Increased age, higher fatigue levels, higher pain score and poorer mental health may explain underestimation of disease activity by physicians. Physicians’ overestimation of disease activity may be explained by higher swollen joint counts.

Residual Disease Burden in Patients With Axial Spondyloarthritis and Psoriatic Arthritis Despite Low Disease Activity States in a Multiethnic Asian Population

“…Current tools that assess disease activity might not have adequately addressed the impact of disease from the patients' perspectives. The discordance in PtGA between patients and their physicians has been described previously in both conditions in the Asian context 37,38 . Our study has shown that pain, fatigue, and the psychological aspects of health were the key burdens of residual disease in both spectra of SpA; these aspects are usually less recognized by physicians.…”

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

“…Previous cross‐sectional studies have demonstrated that positive discordance in RA (ie, higher PGA of RA activity as compared to PhGA) is associated with pain, functional disability, and various other impairments, such as fatigue, anxiety, and sleep disturbance 5–8,12–16 . In contrast, only few studies have investigated the transition of PGA‐PhGA discordance over time 9,18,19 . In this study, we investigated the clinical variables predictive of future positive discordance based on the nationwide NinJa RA database in Japan.…”

“…[5][6][7][8][12][13][14][15][16] In contrast, only few studies have investigated the transition of PGA-PhGA discordance over time. 9,18,19 As for the cutoff value for discordance in global assessment of disease activity, we used 3 cm as a cutoff in the present study, since a systematic literature review by Desthieux et al demonstrated that a difference of ≥3 cm on a 10-cm VAS scale was most frequently used to define discordance. 5 In addition, we used 3 ± 1 cm (2, 3, and 4 cm) as the cutoff value in our previous report investigating the determinants of PGA-PhGA discordance in NinJa 2015 and demonstrated that the determinants were not affected even when cutoff values other than 3 cm were used.…”

“…[5][6][7][12][13][14][15][16][17] However, few longitudinal studies have investigated the shift in PGA-PhGA discordance over time in patients with RA. 9,18,19 Karpouzas et al investigated this shift over 2 years in 536 Hispanic patients with established RA and demonstrated that positive discordance was stable over time and that its presence at baseline increased the likelihood of positive discordance at subsequent visits. 9 This stability of positive discordance suggests that positive discordance in RA in fact represents a patient-specific characteristic.…”

Patient-Centered Care in Psoriatic Arthritis—A Perspective on Inflammation, Disease Activity, and Psychosocial Factors

“…This is clinically important as the evolution of symptoms is often mutually intertwined. Studies have suggested that fatigue, pain, and poor mental health predispose to underrepresentation of disease activity, while reliance on swollen joint counts may lead to the contrary [ 86 ]. Moreover, remission defined across a variety of composite disease activity indices and patient-reported outcomes can differ and will not always be consistent with more objective surrogates of inflammation.…”