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. 2025 Aug 5;45(8):181.
doi: 10.1007/s00296-025-05933-0.

Discordance between patient and physician reported global disease activity in PsA is associated with mental health-a cross-sectional analysis

Anne C Regierer  1 , Kirsten Karberg  2   3 , Cay-Benedict von der Decken  2   4   5 , Stephanie Lembke  6 , Carlo Veltri  6 , Matthias Englbrecht  7 , Johanna Callhoff  6 , Stefan Kleinert  2   8   9
Affiliations

Discordance between patient and physician reported global disease activity in PsA is associated with mental health-a cross-sectional analysis

Anne C Regierer et al. Rheumatol Int. .

Abstract

Psoriatic arthritis (PsA) is a complex disease with heterogeneous disease manifestations. Composite scores including patient reported parameters are the recommended tools to measure these different aspects. Patient and physician often show discordance in their disease assessment. To describe the discordance between patient (PtGA) and physician reported global disease activity (PhGA) and to show its association with mental health. Descriptive cross-sectional analysis of three independent cohorts of PsA patients - RABBIT-SpA register, national database (NDB), RheumaDatenRheport GbR (RHADAR) network - receiving routine rheumatology care in Germany. Association between depressive symptoms and discordance between PtGA and PhGA was analysed using a linear regression model taking age, sex, and depression score into account. 1931 RABBIT-SpA, 1794 NDB, and 1728 RHADAR patients were analysed. Mean age was 55, 56, and 60 years. Mean discordance (PtGA-PhGA) was 1.8 in RABBIT-SPA, 1.9 in NDB, and 2 in RHADAR. Discordance > = 3 was present in 34% (RABBIT-SpA), 35% (NDB), and 37% (RHADAR). Discordance increased with increasing PtGA. In patients with severe depressive symptoms, discordance was larger than in those with no depressive symptoms. Depressive symptoms were significantly associated with discordance also if age and sex were accounted for. In this analysis of three independent PsA cohorts, we found a clinically meaningful discordance between physician and patient assessed disease activity in more than a third of the patients. As patients report higher levels of disease activity, discordant judgments become increasingly prevalent. Depressive symptoms are strongly associated with discordant assessments of global disease activity.

Keywords: Psoriatic arthritis, Patient reported outcome, Global disease activity, Depression, Observational data.

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Conflict of interest statement

Declarations. Conflict of interest: All authors have declared no conflicts of interest in relation to this analysis. Ethical approval: RABBIT-SpA received approval by the ethics committee of the Charité-Universitätsmedizin Berlin (#EA1/246/16). Ethics approval for the National Database of the Arthritis centres (NDB) was granted by the ethics committee of the Charité-Universitätsmedizin Berlin (EA1/196/06). RheumaDatenRhePort (RHADAR): Ethics approval for the study was not required by the Ethics Committee of the Bavarian State Medical Association, as it was a non-interventional quality assurance evaluation of routine medical care. Informed consent: Patient consent: Written informed consent was obtained in person prior to participation. Each participant received a detailed information sheet and had the opportunity to ask questions before signing the consent form.

Figures

Fig. 1
Fig. 1
Boxplots of patient reported global disease activity (PtGA) and physician reported global disease activity (PhGA). On the x-axis PtGA values (0–10) are shown and on the y-axis PhGA values. The boxplots show the distribution of PhGA values per PtGA value. Boxes range from the 25% percentile to the 75% percentile, the line in the middle of the box shows the median. The pink line shows the discordance between the PtGA median value and the PhGA value A RABBIT-SpA; B NDB; C RHADAR. NDB national data base, RABBIT-SpA German disease register RABBIT-SpA, RHADAR RheumaDatenRhePort
Fig. 2
Fig. 2
Distribution and magnitude of discordance between PtGA and PhGA. <0: PhGA higher than PtGA, > 0: PtGA is higher than PhGA. A RABBIT-SpA; B NDB; C RHADAR. NDB national data base, RABBIT-SpA German disease register RABBIT-SpA, RHADAR RheumaDatenRhePort
Fig. 3
Fig. 3
Categories of depressive symptoms and the discordance between PtGA (dark brown circles) and PhGA (light orange circles). The red lines show the mean difference between PtGA and PhGA for each category of depressive symptoms. WHO-5 > 50: well-being, 29–50: mild depressive symptoms, 13–28: moderate depressive symptoms, 0–13: severe depressive symptoms. A RABBIT-SpA; B NDB; C RHADAR. NDB national data base, RABBIT-SpA German disease register RABBIT-SpA, RHADAR RheumaDatenRhePort, WHO-5 WHO-5 well-being index
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