Discordance and accordance between patient’s and physician’s assessments in rheumatoid arthritis

Abstract

Objectives: The American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) remission criteria for rheumatoid arthritis (RA) are more stringent than index-based criteria, making it more difficult to achieve a patient’s global assessment (PGA) than an evaluator’s global assessment (EGA). We investigated the reason for the discrepancy between the PGA and the EGA in a Japanese clinical cohort.

Method: We assessed clinical and laboratory variables in our clinical cohort. The frequency of remission achievement according to the ACR/EULAR remission criteria and predictors of the discrepancy between the PGA and EGA were analysed.

Results: Of 370 patients with RA, 89 fulfilled PGA criteria and 167 patients fulfilled EGA criteria. The PGA was highly correlated with the visual analogue scale (VAS) pain score and non-inflammatory variables including Steinbrocker class and the Health Assessment Questionnaire Disability Index (HAQ-DI). Conversely, inflammatory variables, including swollen joint count (SJC), tender joint count (TJC), and C-reactive protein (CRP) levels, were significantly associated with the EGA. The main predictors of the discrepancy between the PGA and the EGA were patient’s VAS pain score, SJC, and functional disability.

Conclusions: Increased pain and functional disability led to a discrepancy towards a worse PGA than EGA, whereas increased SJC led to an accordance towards a worse EGA.

Acknowledgements

We thank K Yamamoto at the Division of Clinical and Epidemiology, Department of Health Information Governance, National Cerebral and Cardiovascular Centre, and W Yamamoto at the Kurashiki Sweet Hospital, for their support in the establishment and maintenance of the KURAMA cohort. We also thank K Ohmura and K Murakami at the Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, for advice regarding radiographic analysis. Finally, we thank M Hamaguchi at the Department of Experimental Immunology, Immunology Frontier Research Centre, Osaka University, for his instructions and advice regarding the statistical analyses.