Patient-Physician Discordance in Global Assessment in Rheumatoid Arthritis: A Systematic Literature Review With Meta-Analysis

Abstract

Objective: The integration of the patient in therapeutic decision-making is important in the management of rheumatoid arthritis (RA), but the patient opinion regarding disease status may differ from the physician's opinion. The aim of this study was to assess in the published literature the frequency and drivers of patient-physician discordance in global assessment in RA.

Methods: A systematic literature review of all articles published up to January 2015 in Medline or Embase, reporting discordance in RA, was conducted by 2 investigators. Discordance was defined based on the absolute difference of patient global (PGA) and physician global assessments (PhGA) on 0-10-cm scales. The frequency of discordance and its predictors were collected in each study. Frequencies of discordance were pooled by meta-analysis using random effect.

Results: In all, 12 studies were selected (i.e., 11,879 patients): weighted mean ± SD age was 55.1 ± 13.9 years, weighted mean ± SD disease duration was 10.4 ± 9.3 years, and 80.7% were women. The value of the difference |PGA - PhGA| defining discordance varied between ≥0.5 cm (n = 2 studies) to ≥3 cm (n = 5 studies); the weighted mean value was 2.7 cm. The pooled percentage of patients with discordance was 43% (95% confidence interval 36%-51%; range 25%-76%). PGA was usually higher than PhGA. The drivers of PGA were pain and functional incapacity, whereas drivers of PhGA were joint counts and acute-phase reactants.

Conclusion: Discordance in global assessment was most frequently defined as a difference of 3 points or more; even with such a stringent definition, up to half the patients were found to be discordant. The long-term consequences of this discordance remain to be determined.