Abstract
BackgroundDiscordance between patients with rheumatoid arthritis (RA) and their rheumatology health care providers is a common and important problem. The objective of this study was to perform a comprehensive clinical evaluation of patient-provider discordance in RA.MethodsA cross-sectional observational study was conducted of consecutive RA patients in a regional practice with an absolute difference of ≥ 25 points between patient and provider global assessments (possible points, 0–100). Data were collected for disease activity measures, clinical characteristics, comorbidities, and medications. In a prospective substudy, participants completed patient-reported outcome measures and underwent ultrasonographic assessment of synovial inflammation. Differences between the discordant and concordant groups were tested using χ2 and rank sum tests. Multivariable logistic regression was used to develop a clinical model of discordance.ResultsPatient-provider discordance affected 114 (32.5%) of 350 consecutive patients. Of the total population, 103 patients (29.5%) rated disease activity higher than their providers (i.e., ‘positive’ discordance); only 11 (3.1%) rated disease activity lower than their providers and were excluded from further analysis. Positive discordance correlated with negative rheumatoid factor and anticyclic citrullinated peptide antibodies, lack of joint erosions, presence of comorbid fibromyalgia or depression, and use of opioids, antidepressants, or anxiolytics, or fibromyalgia medications. In the prospective study, the group with positive discordance was distinguished by higher pain intensity, neuropathic type pain, chronic widespread pain and associated polysymptomatic distress, and limited functional health status. Depression was found to be an important mediator of positive discordance in low disease activity whereas the widespread pain index was an important mediator of positive discordance in moderate-to-high disease activity states. Ultrasonography scores did not reveal significant differences in synovial inflammation between discordant and concordant groups.ConclusionsThe findings provide a deeper understanding of patient-provider discordance than previously known. New insights from this study include the evidence that positive discordance is not associated with unrecognized joint inflammation by ultrasonography and that depression and fibromyalgia appear to play distinct roles in determining positive discordance. Further work is necessary to develop a comprehensive framework for patient-centered evaluation and management of RA and associated comorbidities in patients in the scenario of patient-provider discordance.
Highlights
Discordance between patients with rheumatoid arthritis (RA) and their rheumatology health care providers is a common and important problem
The discordant group had a higher median global assessment of disease activity than the concordant group (57 vs. 20; P < .001), whereas provider global assessments were similar between the groups
The present study demonstrates that patients with positive discordance are less likely to be in remission and more likely to be in the low disease activity (LDA) or moderate disease activity (MDA) categories
Summary
Discordance between patients with rheumatoid arthritis (RA) and their rheumatology health care providers is a common and important problem. The objective of this study was to perform a comprehensive clinical evaluation of patient-provider discordance in RA. Discordance between patients with rheumatoid arthritis (RA) and rheumatology health care providers in assessment of disease activity is an important clinical problem. Its associations with impairment in physical function and health-related quality of life highlight the clinical importance of positive discordance [1, 3, 4]. Previous cross-sectional studies have reported that patient-reported measures of pain intensity, fatigue, depression, physical function, and healthrelated quality of life are key correlates of discordance [4, 5]. Whereas the patient global assessment mainly reflects pain, fatigue, and the impact of disease on overall health, the provider global assessment primarily denotes objective disease assessments, swollen joints and inflammatory markers [2, 7]
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have