Determinants of patient-physician discordance in global assessment in psoriatic arthritis: a multicenter European study

Objective: Patient-physician discordance in global assessment of disease activity concerned one third of patients but what does it reflect? We aimed to assess patient-physician discordance in psoriatic arthritis (PsA) and patient-reported domains of health (physical and psychological) associated to discordance.

Methods: The PsAID (Psoriatic Arthritis Impact of Disease) cross-sectional multicenter European study of patients with PsA according to expert opinion was analysed. Patient- and Physician-Global Assessment (PGA and PhGA) were rated with a 0-10 numeric rating scale. Discordance was defined as the difference (PGA–PhGA) and as the absolute difference |PGA-PhGA|≥3 points. Determinants of (PGA-PhGA) were assessed by a stepwise multivariate linear regression among 12 physical and psychological aspects of impact: pain, skin problems, fatigue, ability to work/leisure, functional incapacity, feeling of discomfort, sleep disturbance, anxiety/fear, coping, embarrassment/shame, social participation and depressive affects.

Results: In 460 patients (mean age 50.6±12.9 years, 52.2% female, mean disease duration 9.5±9.5 years, mean DAPSA 30.8±32.4, 40.4% treating by biologics), mean PGA was higher than mean PhGA with a mean absolute difference of 1.9±1.8 points. Discordance defined by |PGA-PhGA|≥3/10 concerned 134 (29.1%) patients and 115 (85.8% of patients with discordance) had PGA>PhGA. Higher fatigue (β=0.14), lower self-perceived coping (β=0.23) and impaired social participation (β=0.16) were independently associated with a higher difference (PGA-PhGA).

Conclusion: Discordance concerned 29.1% of these patient/physician dyads, mainly by PGA>PhGA. Factors associated with discordance were psychological rather than physical domains of health. Discordance was more frequent in patients in remission, indicating more work is needed on the patient perspective regarding disease activity.