Mayu Tago1, Tetsuji Sawada1, Susumu Nishiyama2, Koichiro Tahara1, Eri Kato1, Haeru Hayashi1, Hiroaki Mori1, Jinju Nishino3, Toshihiro Matsui4,5, Shigeto Tohma5. 1. Department of Rheumatology, Tokyo Medical University Hospital, Tokyo, Japan. 2. Rheumatic Disease Center, Kurashiki Medical Center, Okayama, Japan. 3. Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan. 4. Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan. 5. Department of Rheumatology, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara Hospital, Kanagawa, Japan.
Abstract
OBJECTIVES: The discordance between patient global assessment (PGA) and physician global assessment (PhGA) of rheumatoid arthritis (RA) disease activity may be problematic in clinical practice. The aim of this study was to identify determinants of this discordance using a nationwide RA database in Japan (NinJa) with special attention to large joint involvement. METHODS: We investigated 12 043 adults with RA and used a discordance cutoff of 3 cm. Large joint involvement was investigated using novel joint indices (x, y, z), where x and y were the indices for upper and lower joints, respectively, and z was for large joint predominance. Predictors of PGA-PhGA discordance and determinants of PGA and PhGA were analyzed by multivariate logistic and linear regression models, respectively. RESULTS: Multivariate logistic regression identified age, pain and high modified Health Assessment Questionnaire score as predictors of positive discordance (PGA ≥ PhGA), whereas parameters of disease activity in RA (C-reactive protein, x and y), class 3-4 functional status, and z were found to predict against positive discordance. Linear regression analysis revealed that PGA was mainly determined by pain, whereas PhGA was determined by various other factors. CONCLUSIONS: RA care providers should focus on pain and functional disability to decrease PGA-PhGA discordance. High disease activity and large joint involvement decreased PGA-PhGA discordance, indicating that the number and distribution of affected joints influenced the perception of disease activity by patients with RA and their physicians.
OBJECTIVES: The discordance between patient global assessment (PGA) and physician global assessment (PhGA) of rheumatoid arthritis (RA) disease activity may be problematic in clinical practice. The aim of this study was to identify determinants of this discordance using a nationwide RA database in Japan (NinJa) with special attention to large joint involvement. METHODS: We investigated 12 043 adults with RA and used a discordance cutoff of 3 cm. Large joint involvement was investigated using novel joint indices (x, y, z), where x and y were the indices for upper and lower joints, respectively, and z was for large joint predominance. Predictors of PGA-PhGA discordance and determinants of PGA and PhGA were analyzed by multivariate logistic and linear regression models, respectively. RESULTS: Multivariate logistic regression identified age, pain and high modified Health Assessment Questionnaire score as predictors of positive discordance (PGA ≥ PhGA), whereas parameters of disease activity in RA (C-reactive protein, x and y), class 3-4 functional status, and z were found to predict against positive discordance. Linear regression analysis revealed that PGA was mainly determined by pain, whereas PhGA was determined by various other factors. CONCLUSIONS:RA care providers should focus on pain and functional disability to decrease PGA-PhGA discordance. High disease activity and large joint involvement decreased PGA-PhGA discordance, indicating that the number and distribution of affected joints influenced the perception of disease activity by patients with RA and their physicians.
Authors: Emily Rose; Marcela A Ferrada; Kaitlin A Quinn; Wendy Goodspeed; Laurent Arnaud; Aman Sharma; Hajime Yoshifuji; Jeff Kim; Clint Allen; Arlene Sirajuddin; Marcus Chen; Peter C Grayson Journal: Arthritis Care Res (Hoboken) Date: 2022-04-29 Impact factor: 5.178
Authors: Maria Fernanda Brandão Resende Guimarães; Maria Raquel da Costa Pinto; Gustavo Gomes Resende; Carla Jorge Machado; Ana Beatriz Vargas-Santos; Rodrigo Balbino Chaves Amorim; Ana Paula Monteiro Gomides; Cleandro Pires de Albuquerque; Manoel Barros Bértolo; Paulo Louzada Júnior; Isabela Araújo Santos; Rina Dalva Neubarth Giorgi; Nathalia de Carvalho Saciloto; Sebastião Cezar Radominski; Fernanda Maria Borghi; Karina Rossi Bonfiglioli; Henrique Carriço da Silva; Maria de Fátima L da Cunha Sauma; Marcel Lobato Sauma; Júlia Brito de Medeiros; Ivânio Alves Pereira; Gláucio Ricardo Werner de Castro; Claiton Viegas Brenol; Ricardo Machado Xavier; Licia Maria Henrique Mota; Geraldo da Rocha Castelar-Pinheiro Journal: PLoS One Date: 2020-03-13 Impact factor: 3.240