Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Clinical Trial
. 2016 May 21;18(1):114.
doi: 10.1186/s13075-016-1004-3.

Discordance between patient and physician assessments of global disease activity in rheumatoid arthritis and association with work productivity

Josef S Smolen  1 , Vibeke Strand  2 , Andrew S Koenig  3 , Annette Szumski  4 , Sameer Kotak  5 , Thomas V Jones  3
Affiliations
Clinical Trial

Discordance between patient and physician assessments of global disease activity in rheumatoid arthritis and association with work productivity

Josef S Smolen et al. Arthritis Res Ther. .

Abstract

Background: Discordance between patient and physician ratings of rheumatoid arthritis (RA) severity occurs in clinical practice and correlates with pain scores and measurements of joint disease. However, information is lacking on whether discordance impacts patients' ability to work. We evaluated the discordance between patient and physician ratings of RA disease activity before and after treatment with etanercept and investigated the associations between discordance, clinical outcomes, and work productivity.

Methods: In the PRESERVE clinical trial, patients with moderate RA received open-label etanercept 50 mg once weekly plus methotrexate for 36 weeks. Baseline and week-36 disease characteristics and clinical and work productivity outcomes were categorized according to week-36 concordance category, defined as positive discordance (patient global assessment - physician global assessment ≥2), negative discordance (patient global assessment - physician global assessment ≤ -2), and concordance (absolute difference between the two disease activity assessments = 0 or 1). Correlations between discordance, clinical outcomes, and predictors of discordance were determined.

Results: At baseline, 520/762 (68.2 %) patient and physician global assessment scores were concordant, 194 (25.5 %) were positively discordant, and 48 (6.3 %) were negatively discordant. After 36 weeks of therapy, 556/763 (72.9 %) scores were concordant, 189 (24.8 %) were positively discordant, and 18 (2.4 %) were negatively discordant. Patients with week-36 concordance had the best 36-week clinical and patient-reported outcomes, and overall, the greatest improvement between baseline and week 36. Baseline pain, swollen joint count, duration of morning stiffness, fatigue, and patient general health significantly correlated with week-36 discordance, p < 0.0001 to p < 0.05. Additionally, baseline pain, patient general health, and C-reactive protein were predictors of week-36 discordance (odds ratios 1.22, 1.02, and 0.98, respectively). For the employed patients, percent impairment while working and percent overall work impairment were highest (greatest impairment) at baseline and 36 weeks in the group with positive discordance.

Conclusions: The percentage of patients with concordance increased after 36 weeks of treatment with etanercept, with concordant patients demonstrating the greatest improvement in clinical and patient-reported outcomes. Discordance correlated with several measures of disease activity and was associated with decreased work productivity.

Trial registration: ClinicalTrials.gov identifier: NCT00565409 . Registered 28/11/2007.

Keywords: Discordance; Etanercept; PRESERVE; Rheumatoid arthritis; Work productivity.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Shifts in discordance categories, baseline to week 36 (n = 762). Positive discordance: patient global assessment – physician global assessment ≥2. Negative discordance: patient global assessment – physician global assessment ≤ –2. Concordance: patient global assessment – physician global assessment = 0 or 1
See this image and copyright information in PMC

References

    1. Barton JL, Imboden J, Graf J, et al. Patient-physician discordance in assessments of global disease severity in rheumatoid arthritis. Arthritis Care Res. 2010;62(6):857–64. doi: 10.1002/acr.20132. - DOI - PMC - PubMed
    1. Castrejón I, Yazici Y, Samuels J, Luta G, Pincus T. Discordance of global estimates by patients and their physicians in usual care of many rheumatic diseases: association with 5 scores on a multidimensional health assessment questionnaire (MDHAQ) that are not found on the health assessment questionnaire (HAQ) Arthritis Care Res. 2014;66(6):934–42. doi: 10.1002/acr.22237. - DOI - PubMed
    1. Kaneko Y, Kuwana M, Kondo H, Takeuchi T. Discordance in global assessments between patient and estimator in patients with newly diagnosed rheumatoid arthritis: associations with progressive joint destruction and functional impairment. J Rheumatol. 2014;41(6):1061–6. doi: 10.3899/jrheum.131468. - DOI - PubMed
    1. Khan NA, Spencer HJ, Abda E, et al. Determinants of discordance in patients' and physicians' rating of rheumatoid arthritis disease activity. Arthritis Care Res. 2012;64(2):206–14. doi: 10.1002/acr.20685. - DOI - PMC - PubMed
    1. Lindström Egholm C, Krogh NS, Pincus T, et al. Discordance of global assessments by patient and physician is higher in female than in male patients regardless of the physician’s sex: data on patients with rheumatoid arthritis, axial spondyloarthritis, and psoriatic arthritis from the DANBIO Registry. J Rheumatol. 2015;42(10):1781–5. - PubMed

Publication types

Associated data