THU0135 DETERMINANTS OF DISCORDANCE IN PATIENT’S AND PHYSICIAN’S GLOBAL ASSESSMENTS OF DISEASE ACTIVITY OF RHEUMATOID ARTHRITIS IN THE “REAL” STUDY – BRAZIL
Authors: Maria Fernanda Guimarães, Maria Raquel Pinto, Gustavo Resende, Carla Machado, Ana Beatriz Vargas-Santos, Cleandro Albuquerque, Manoel Bertolo, Paulo Louzada, Rina Giorgi, Sebastiao Radominski, Karina Bonfiglioli, Maria de Fátima Sauma, Ivanio Pereira, Claiton Brenol, Licia Mota, Geraldo Castelar-Pinheiro
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Discordance between the patient's global assessment of disease activity (PGA) and examiner's global assessment (EGA) has been described in rheumatoid arthritis (RA) (1,2). Understanding the reasons for this discrepancy is essential in the context of treat-to-target treatment strategy. <h3>Objectives</h3> To assess the determinants of PGA and EGA and factors associated with discordance between them. <h3>Methods</h3> The REAL study included RA patients from Brazilian public health centers. Clinical, laboratory and outcomes measures were collected. PGA and EGA were rated on a visual analog scale and analyzed. Three groups were defined: no discordance (a difference between PGA and EGA within 3 cm), positive discordance (PGA exceeding EGA by &gt;3 cm), and negative discordance (PGA less than EGA by &gt;3 cm). Multivariate regression analysis was used to identify determinants of PGA and EGA and their discordance. <h3>Results</h3> 1115 patients (89,4% female, mean age 56.7y and median disease duration of 12.7y) were enrolled. Two factors were associated with PGA in the final multivariate model: one point increase in the pain scale (PS) leads to an increase of 0.62 in PGA; one point increase in HAQ increases by 9,25 points the PGA. The factors associated with EGA were: PS, number of tender and swollen joints (NTJ and NSJ), RF, ESR, HAQ and use of corticosteroids. Discordance between patient and physician was found in 30.52%: positive discordance (PD) in 24.6% and negative discordance (ND) in 5.92%. An increase of one point in the NSJ was associated with a 12% increase in the chance of ND. The chance of PD increased by 90% and 2% for each unit increased in HAQ and PS respectively. Finally, the chance of PD decreased by 3% for each point increased in NTJ and by 15% for each point increased in NSJ. <h3>Conclusion</h3> In one-third of the assessments, there was disagreement between PGA and EGA (a PD in 80% of them). Pain and function were determinants for patients to estimate disease activity, while swollen joints were the main factor related to a worse examiner's evaluation. These data show how different can be the perspectives of patients and assistants. <h3>References</h3> [1] Smolen JS, Strand V, Koenig AS, Szumski A, Kotak S, Jones TV. Discordance between patient and physician assessments of global disease activity in rheumatoid arthritis and association with work productivity. Arthritis Res Ther. 2016; 18:114. [2] Desthieux C, Hermet A, Granger B, Fautrel B, Gossec L. Patient-physician discordance in global assessment in rheumatoid arthritis: a systematic literature review with meta-analysis. Arthritis Care Res (Hoboken). 2016; 68:1767. <h3>Disclosure of Interests</h3> Maria Fernanda Guimarães: None declared, Maria Raquel Pinto: None declared, Gustavo Resende Grant/research support from: ABBVIE, PFIZER, Consultant for: ABBVIE, JANSSEN, NOVARTIS, Paid instructor for: Novartis, Janssen, Speakers bureau: ABBVIE, JANSSEN, NOVARTIS, PFIZER, UCB, Carla Machado: None declared, Ana Beatriz Vargas-Santos Grant/research support from: Has received personal fees and/or non-financial support from Pfizer, AbbVie, AstraZeneca, Janssen, Bristol-Myers Squibb, Roche, Novartis and UCB, Cleandro Albuquerque Shareholder of: Has received personal fees and/or non-financial support from Pfizer, AbbVie, AstraZeneca, Janssen, Bristol-Myers Squibb, Roche, Novartis and UCB, Grant/research support from: Has received personal fees and/or non-financial support from Pfizer, AbbVie, AstraZeneca, Janssen, Bristol-Myers Squibb, Roche, Novartis and UCB, Consultant for: Has received personal fees and/or non-financial support from Pfizer, AbbVie, AstraZeneca, Janssen, Bristol-Myers Squibb, Roche, Novartis and UCB, Paid instructor for: Has received personal fees and/or non-financial support from Pfizer, AbbVie, AstraZeneca, Janssen, Bristol-Myers Squibb, Roche, Novartis and UCB, Speakers bureau: Has received personal fees and/or non-financial support from Pfizer, AbbVie, AstraZeneca, Janssen, Bristol-Myers Squibb, Roche, Novartis and UCB, Manoel Bertolo Speakers bureau: Has delivered speeches at events sponsored by AbbVie and Pfizer, Paulo Louzada Jr Consultant for: Has received consulting fees from Pfizer, Rina Giorgi Consultant for: Has received consulting fees from Roche, Pfizer, Bristol-Myers Squibb, UCB, Eli-Lilly, AbbVie, Abbott and EMS, Speakers bureau: Has received speaking fees from Roche, Pfizer, Bristol-Myers Squibb, UCB, Eli-Lilly, AbbVie, Abbott and EMS, Sebastiao Radominski Consultant for: Abbvie, Celgene, Genentech/Roche, Janssen, Pfizer, UCB, Speakers bureau: Abbvie, Celgene, Genentech/Roche, Janssen, Pfizer, UCB, Karina Bonfiglioli Speakers bureau: Has received speaking fees from Roche, Pfizer, Bristol-Myers Squibb, Abbvie and Janssen., Maria de Fátima Sauma: None declared, Ivanio Pereira Consultant for: Has received consulting fees from Roche, Pfizer, UCB Pharma, Eli-Lilly, Abbvie and Janssen, Speakers bureau: Has received speaking fees Roche, Pfizer, UCB Pharma, Eli-Lilly, Abbvie and Janssen, Claiton Brenol Shareholder of: Has participated in clinical and/or experimental studies related to this work and sponsored by AbbVie, BMS, Janssen, Pfizer and Roche; has received personal or institutional support from AbbVie, BMS, Janssen, Pfizer and Roche; has delivered speeches at events related to this work and sponsored by AbbVie, Janssen, Pfizer and Roche, Grant/research support from: Has participated in clinical and/or experimental studies related to this work and sponsored by AbbVie, BMS, Janssen, Pfizer and Roche; has received personal or institutional support from AbbVie, BMS, Janssen, Pfizer and Roche; has delivered speeches at events related to this work and sponsored by AbbVie, Janssen, Pfizer and Roche, Consultant for: Has participated in clinical and/or experimental studies related to this work and sponsored by AbbVie, BMS, Janssen, Pfizer and Roche; has received personal or institutional support from AbbVie, BMS, Janssen, Pfizer and Roche; has delivered speeches at events related to this work and sponsored by AbbVie, Janssen, Pfizer and Roche, Paid instructor for: Has participated in clinical and/or experimental studies related to this work and sponsored by AbbVie, BMS, Janssen, Pfizer and Roche; has received personal or institutional support from AbbVie, BMS, Janssen, Pfizer and Roche; has delivered speeches at events related to this work and sponsored by AbbVie, Janssen, Pfizer and Roche, Speakers bureau: Has delivered speeches at events sponsored by AbbVie, Janssen, Pfizer and Roche, Licia Mota Speakers bureau: Has delivered speeches at events sponsored by AbbVie, Janssen, Pfizer, Roche and UCB., Geraldo Castelar-Pinheiro Consultant for: Has received consulting fees from AbbVie, Bristol-Myers Squibb, Eli Lilly, Glaxosmithkline, Janssen, Pfizer, Sanofi Genzyme and Roche