THU0108 11. RHEUMATOID ARTHRITIS – PROGNOSIS, PREDICTORS AND OUTCOME CONCORDANCE BETWEEN PHYSICIAN AND PATIENT ASSESSMENT OF DISEASE ACTIVITY IN RHEUMATOID ARTHRITIS USING DISEASE ACTIVITY SCORE
Authors: Nelly Ziade, Amani Daher, Bassel Zorkany, Samar Al Emadi, Hussein Halabi, Mohammad Abu Jbara, Lina Kibbi, Sahar Saad, Manal Mashaleh, Georges Merheb, Elie Alam, Kamel Mroue’, Jamil Messaykeh, Alla Ayko, Humeira Badsha, Ghita Harifi, Nelly Salloum, Thurayya Arayssi, Basel Masri
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Involving patients with rheumatoid arthritis (RA) in the assessment of their disease may increase adherence to treatment, improve disease outcomes and reduce consultation time. <h3>Objectives:</h3> To evaluate the concordance between physician and patient assessment of disease activity in RA using Disease Activity Score (DAS-28). <h3>Methods:</h3> During the routine consultation, patients were briefed about DAS-28 by their rheumatologist. Using a standard DAS-28 mannequin, physicians, patients and nurses reported the number of tender and swollen joint, inflammatory markers and global health on a 0-10 Likert scale. DAS-28, Clinical Disease Activity Index (CDAI) and Simple Disease Activity Index (SDAI) were calculated blindly by each participant. Agreement between physician- and patient-DAS categories was calculated using weighted kappa (WK) for category comparison. Concordance between physician- and patient-DAS was estimated using the Bland-Altman method. Predictive factors of positive concordance between physician and patient-DAS were identified using logistic regression. <h3>Results:</h3> Four hundred and twenty patients from 7 Middle-Eastern countries were included, with a mean age of 49 years (SD 12), 84% of females, disease duration of 11 years (SD 8). Mean physician-DAS-28 was 4.03 (SD 1.51). 65% had positive rheumatoid factor, 56% had positive ACPA, 30% had erosive disease and 34% were on biotherapy. Agreement between physician- and patient-DAS categories was 89%, WK was 0.84. WK were 0.80 for DAS physician-nurse, 0.79 for DAS patient-nurse, 0.83 for CDAI physician-patient and 0.88 for SDAI physician-patient agreements respectively. All activity measures were higher in patients compared to physicians, except for the swollen joints count. The mean difference between physician- and patient-DAS was -0.09 [95% CI -0.14; -0.04] and was smaller in patients in remission (Figure 1: Bland Altman plot). Concordance was statistically associated with CRP and patient SDAI. <h3>Conclusion:</h3> Concordance between patient and physician assessment of disease activity in RA was excellent and was higher using SDAI followed closely by DAS-28 and CDAI. Self-assessment of disease activity should be decided according to the physician’s clinical judgment. <h3>References:</h3> [1] Gossec L, et al. Arthritis Rheumatol 2016; 68 (suppl 10). [2] Smolen J, et al. Arthritis Research &amp; Therapy (2016) 18:114. [3] Studenic Pet al. Arthritis Rheumatol. 2012;64(9):2814–23. The physician-patient DAS-mean is plotted on the X-axis. The physician-patient DAS-difference is plotted on the Y-Axis. The horizontal black line corresponds to the mean DAS difference (-0.09 [95% CI -0.14; -0.04]). The horizontal blue lines correspond to +/-1.96 SD. The vertical red line corresponds to the DAS-28 cut-off for remission (2.6). <h3>Disclosure of Interests:</h3> None declared