Discordance Between Clinical Perception and Objective Data of RA Disease Remission

The discordance between rheumatologist perception of remission and standardized measures suggests that the use of validated steps is key in determining remission among patients with rheumatoid arthritis (RA), according to research results published in BMC Rheumatology.

Researchers examined both the prevalence and the types of discordance between physician perspectives on RA disease remission and data objectively assessed via standardized measures. Data were pulled from the cross-sectional, geographically diverse Adelphi Real-World RA Disease Specific Program (DSP), and included eligible US rheumatologists who met the inclusion criteria.

The 2014 DSP survey included 101 rheumatologists in the United States and also records from 843 patients with RA. A majority of the rheumatologists were men (72.3%) who were located primarily in the East or Midwest (36.6% and 28.7%, respectively) of the US; 38.6% of rheumatologists worked in an office-based practice.

Among participating rheumatologists, 56.4% used only clinical judgment to assess disease remission in RA. According to the researchers, the most commonly used standardized measures of disease activity were Disease Activity Score in 28 joints (DAS28) and the Routine Assessment of Patient Index Data (36.6% and 32.7%, respectively).

Discordance was analyzed using 531 patient records from 78 rheumatologists. Among this group, 49.7% were in remission based on rheumatologist evaluation, and 30.7% were eligible based on the calculation of the DAS28-erythrocyte sedimentation rate (DAS28(3)-ESR) scores. When compared with DAS28(3)-ESR criteria, researchers found that 25.8% of the patients’ disease remission was classified as rheumatologist-negative discordance, based on physicians’ clinical perceptions.

Patients classified as rheumatologist-negative discordant were typically older, had a longer duration of diagnosis of RA, and were more commonly treated in an office-only setting (P <.05). These patients also were more likely to experience a higher level of pain and an increase in joint inflammation and damage, including cartilage destruction, bone thinning, and/or synovium inflammation (P <.005). Additionally, these patients were primarily treated with biologic disease-modifying antirheumatic drugs, without a treat-to-target strategy in place (P <.05).

In both the multivariate and Clinical Disease Activity Index sensitivity analyses, RA diagnosis duration was independently associated with a rheumatologist-negative discordance outcome (odds ratio [OR], 1.12; 95% CI, 1.024-1.220; P =.013).

Limitations to the study included a potential lack of generalizability among rheumatologists across the clinical spectrum, and the use of the DAS28(3)-ESR measure vs the more common, DAS28(4)-ESR.

“Increasing the use of validated measures during the clinical evaluation of the RA patient may better inform treatment decisions, reduce variability in delivery of patient care, and in combination with protocol-specific treatment adjustments, may ultimately improve RA patient outcomes,” the researchers of the study concluded.

Disclosures: This study was sponsored by Sanofi and Regeneron Pharmaceuticals, Inc. Drs Wei, Sullivan, Blackburn, Chen, Piercy, and Curtis, report relationships with the pharmaceutical industry. For a complete list of disclosures, please see the full text of the study online.

Reference

Wei W, Sullivan E, Blackburn S, Chen C-I, Piercy J, Curtis JR. The prevalence and types of discordance between physician perception and objective data from standardized measures of rheumatoid arthritis disease activity in real-world clinical practice in the US. BMC Rheumatol. 2019;3:25. doi:10.1186/s41927-019-0073-8