Age, level of fatigue, pain score, number of swollen joints, and mental health are linked to patient-physician discordance in patients with psoriatic arthritis (PsA), according to the results of a prospective cohort study published in the International Journal of Rheumatic Diseases.

The investigators sought to explore the factors related to patient-physician discordance in an Asian cohort of patients with PsA. Clinical, sociodemographic, and patient-reported outcomes were compiled using a standardized protocol at baseline, 4 months, 8 months, 1 year, 2 years, and 5 years. In this study, patient-physician discordance was defined as patient global assessment minus physician global assessment (PGA-PhGA).

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A total of 142 patients were enrolled in the study; 51.4% were men and 66.2% were of Chinese ethnicity. Mean patient age was 51.1±13.8 years; mean duration of PsA was 27.5±98.3 months. Paired results for PGA-PhGA were available for 291 visits from all patients, with median follow-up of 11.6±17 months. In these 291 patient visits, the overall discordance rates were 33.7% (12.4% positive and 21.3% negative).

According to univariable analysis of the 291 visits, fatigue and pain were both strongly linked to PGA, but only moderately linked to PhGA. In contrast, tender and swollen joint counts were strongly correlated with PhGA, but only moderately correlated with PGA. Duration of illness, pain, fatigue, tender and swollen joint count, dactylitis count, and health-related quality of life domains (measured using the Short Form-36) were all significantly associated with patient-physician discordance.

According to multivariable analysis, age, level of fatigue, and pain score were all positively associated with patient-physician discordance, whereas swollen joint count and poorer mental health were both negatively associated with patient-physician discordance.

The investigators concluded that older age, higher levels of fatigue, higher pain scores, and poorer mental health may help explain the underestimation of PsA disease activity by physicians. However, physicians’ overestimation of PsA disease activity may be explained by higher swollen joint counts.

Reference

Wang CTM, Kwan YH, Fong W, Xiong SQ, Leung YY. Factors associated with patient-physician discordance in a prospective cohort of patients with psoriatic arthritis: an Asian perspective [published online April 3, 2019]. Int J Rheum Dis. doi:10.1111/1756-185X.13568