POS0275-HPR CONCORDANCE BETWEEN THE PHYSICIAN’S AND THE NURSE’S ASSESSMENT OF DISEASE ACTIVITY IN RHEUMATOID ARTHRITIS USING DAS-28, CDAI AND SDAI IN SEVEN MIDDLE EASTERN ARAB COUNTRIES
Authors: N. Ziade, B. Zorkany, S. Al Emadi, M. Abu Jbara, H. Halabi, S. Saad, L. Kibbi, M. Mashaleh, H. Badsha, G. Harifi, A. Ayko, E. Alam, A. Daher, B. Masri, G. Merheb, J. Messaykeh, K. Mroue’, N. Salloum, T. Arayssi
Journal: Annals of the Rheumatic Diseases (2021)

Background: Managing patients with chronic rheumatic diseases is increasingly relying on the collaboration of a multidisciplinary team, including the rheumatology nurse who can aid assessment of disease activity among other healthcare tasks. However, this practice, although common in Europe and North America, is still poorly implemented in the Middle eastern Arab countries (MEAC). Objectives: To evaluate the concordance between the physician’s and the nurse’s assessment of disease activity in patients with rheumatoid arthritis (RA) in the MEAC. Methods: During a routine patient visit to one of 9 rheumatology clinics located in 7 Middle Eastern Arab countries, the physician and the rheumatology nurse (who was already working in the clinic) performed the disease activity score 28 (DAS), Clinical Disease Activity Index (CDAI) and Simple Disease Activity Index (SDAI) in a blinded manner. The concordance regarding the 3 continuous scores was calculated using paired t-test. The agreement between physician- and nurse-DAS categories (remission, low, moderate and high disease activity) was calculated using weighted kappa for category comparison. Predictive factors of positive concordance between physician- and nurse-DAS were identified using binary logistic regression. Results: The study included 373 patients’ measurements over a period of two years (2018 to 2019). The mean age of the patients was 49.6 years (±28.2), 82.6% were females, and the mean disease duration was 11.3 years (±7.5). The mean physician-DAS was slightly higher (3.97 (±1.52)) than the nurse-DAS (3.90 (±1.54)) (p=0.002), with a mean difference of +0.08 [95%CI 0.03; 0.12] (Table 1). The difference in the DAS individual items, the CDAI and the SDAI were not statistically significant. Table 1. Comparison of the disease activity measures reported by the physician and by the nurse. Physician Nurse p-value Total Joint Count 4.87 (2.26) 5.02 (6.20) 0.152 Swollen Joint Count 2.13 (3.88) 2.15 (3.83) 0.790 Global Assessment 3.30 (2.41) 3.32 (2.43) 0.702 DAS-28 3.97 (1.52) 3.90 (1.54) 0.002 CDAI 14.26 (12.53) 14.38 (12.59) 0.515 SDAI 21.51 (23.57) 21.61 (21.66) 0.527 When analyzing DAS as a categorical 4-items variable, the agreement between the physician and the nurse was present in 79.36% of the cases (weighted kappa was 0.77 [95%CI 0.73;0.83] which is considered as excellent, and was higher in patients with high disease activity (Figure 1). A positive concordance between the physician- and the nurse-DAS was associated with the country (higher in Egypt, p&lt;0.001) and the status of higher disease activity (p&lt;0.001). Conclusion: The agreement between the DAS-28 performed by the physician and by the nurse was excellent and was associated with the country and a higher disease activity. The present study confirms that the support of a trained nurse for evaluating disease activity in RA is feasible in the Arab countries and may save some valuable time in the clinic, whilst maintaining the quality of care for patients with RA. Figure 1. Agreement between physician- and nurse-DAS categories Acknowledgements: The authors would like to acknowledge the patients for participating in the study and the assistants/ students/ nurses who assisted in the data collection: Dr. Fatima Abdul Majeed Al Hawaj, M. Atef Ahmed, M. Mohammad Alhusamiah, Ms Raquel De Guzman, Ms Lina Razzouk. Disclosure of Interests: None declared