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Observational Study
. 2025 Mar 12;45(4):70.
doi: 10.1007/s00296-025-05819-1.

Discordance between patient and physician global assessments of psoriatic arthritis activity: an observational study in 13 Arab countries

Noura Abbas  1 , Ihsane Hmamouchi  2   3 , Lina El Kibbi  4 , Avin Maroof  5 , Bassel Elzorkany  6 , Nizar Abdulateef  7 , Asal Adnan  8 , Nabaa Ihsan  8 , Faiq Isho Gorial  7 , Nada Al Chama  9 , Chafika Haouichat  10   11 , Fatima Alnaimat  12 , Suad Hannawi  13 , Saed Atawnah  14 , Hussein Halabi  15 , Manal Al Mashaleh  16 , Laila Aljazwi  17 , Ahmed Abogamal  18 , Laila Ayoub  19 , Elyes Bouajina  20 , Rachid Bahiri  21 , Sahar Saad  22   23 , Maha Sabkar  22 , Krystel Aouad  24 , Nelly Ziadé  25 , Laure Gossec  26   27
Affiliations
Observational Study

Discordance between patient and physician global assessments of psoriatic arthritis activity: an observational study in 13 Arab countries

Noura Abbas et al. Rheumatol Int. .

Abstract

Discordance between physicians and patients in assessing psoriatic arthritis (PsA) activity is common and might impact treatment adherence and decision-making. Cultural and belief systems may influence this discordance. This study aimed to assess the extent of patient-physician discordance in PsA in Arab countries and its association with demographic and disease characteristics.The TACTIC study was a cross-sectional observational study across 13 Arab countries in 2022. Patient and physician global assessments (PGA, PhGA) of disease activity (0-10 scale) were collected, along with demographic and disease data, Disease Activity in Psoriatic Arthritis (DAPSA), and Psoriatic Arthritis Impact of Disease (PsAID). Discordance was defined as an absolute difference of |PGA-PhGA|> 2. Its association with patient characteristics was analyzed through multivariable multinomial logistic regression. In 538 patients (317 females, 58.9%), with a mean age of 45.5 ± 13.2 years and PsA duration of 8.8 ± 7.3 years, the disease was moderately active (mean DAPSA 19.3 ± 16.1; mean PsAID 3.86 ± 2.33). Mean PGA was higher than mean PhGA (4.7 ± 2.5 versus 4.0 ± 2.4, p < 0.001) with an absolute difference of 1.30 ± 1.41 and a high correlation between global assessments (r = 0.74). Discordance was infrequent, occurring in 84 patients (15.6%), and was mostly due to higher PGA (70/84, 83.3%). Discordance (one-point increase) was associated with a lower PhGA (Odds ratio (OR) 3.03 [95%CI 2.18-4.22]), positive fibromyalgia screening (OR 1.28 [95%CI 1.03-1.58]), higher DAPSA (OR 1.16 [95%CI 1.03-1.09]), and higher PsAID scores (OR 2.63 [95%CI 1.96-3.54]). Discordance was primarily identified in patients with moderate disease activity. Discordance between PGA and PhGA was infrequent in Arab countries, suggesting strong patient-physician alignment. Expectations and disease perceptions may play a role in this discordance.

Keywords: Arab World; Patient Global Assessment; Patient Reported Outcome Measures; Patient-Physician Discordance; Physician Global Assessment; Psoriatic Arthritis.

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Conflict of interest statement

Declarations. Conflict of interest: All authors declare that they have no competing interest to disclose in relation to this study. Ethics: Informed consent was obtained from all participants. This is an ancillary study of TACTIC, which was approved by the Ethics Committee of Hotel-Dieu de France Hospital (Lebanon) and by the Institutional Review Boards of the participating countries, when necessary, according to local requirements. The authors declare that no part of this manuscript, including the text and graphics, is copied or published elsewhere in whole or in part. All work was performed solely by the authors.

References

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