POS0545 DISCORDANCE BETWEEN PATIENT’S AND PHYSICIAN’S DISEASE ACTIVITY ASSESSMENT IN RHEUMATOID ARTHRITIS: WHICH DOMAINS CAN INFLUENCE THIS DISCREPANCY WHEN REMISSION IS ACHIEVED?
Authors: L. Moschetti, C. Bazzani, F. Villanova, R. Gorla, F. Franceschini
Journal: Annals of the Rheumatic Diseases (2021)

Background: In daily clinical practice, it is not rare to observe a relevant discordance between patient’s global assessment (PGA) and physician’s global assessment (PhGA), because of different illness perceptions. Objectives: To evaluate the presence of PGA/PhGA discrepancy in patients with rheumatoid arthritis (RA) who achieved biological remission and to explore whether this discordance could be influenced by the presence of additional elements affecting patients’ quality of life, such as comorbidities, sleep disturbances and psycho-emotional factors. Methods: Our study included adult RA patients, followed in a single rheumatology centre, fulfilling three out of four Boolean remission criteria: tender joint count ≤1, swollen joint count ≤1 and C reactive protein ≤1 mg/dl 1 . Medical records including demographic data, clinical characteristics and outcomes measures were collected. To evaluate the impact of comorbidities we used the Rheumatic Disease Comorbidity Index (RDCI). Pain assessment, PGA and PhGA were rated on a visual analogue scale (0-100 mm) on the same day of the clinical evaluation. To analyse the discrepancy between PGA and PhGA, the [PGA-PhGA] variable was calculated, considering as discordant a difference ≥ 30 mm. All the subjects completed the following questionnaires: Health Assessment Questionnaire (HAQ), SF36 Health Survey, State-Trait Anxiety Inventory (STAI-Y1/Y2), Self-rating Depression Scale (SDS Zung) and Insomnia Severity Index (ISI). Statistical analysis was performed to compare concordant and discordant groups. Results: The study included 90 patients (64 women, 26 men) with a median age of 60 [50-67] and a median RA duration of 10 [5-16] years; 80% of patients were RF and/or ACPA positive. According to DAS28 (median 1.7 [1.5-2.2]), 90% of patients achieved remission, 9% LDA and 1% MDA. Nevertheless, in 81% of cases PGA&gt;PhGA and in 33% [PGA-PhGA] ≥30. The discordant group showed higher median disease activity scores (DAS28: 2.2 [1.9-2.4] vs 1.5 [1.4-1.9], p&lt;0,001 ; SDAI: 6.7 [3.9-8.1] vs 2.0 [0.7-3.2], p&lt;0.001 ). No differences were found in gender, age, comorbidities, RA duration, serology and treatment (cs-/b-DMARDs). Median prednisone dose was higher in the discordant group (0 [0-21] vs 0 [0-7.5] mg/week, p:0,024 ). Data about patient-reported outcomes and differences between two groups are reported in the table 1. Conclusion: In our study we found discordance between the global disease assessment reported by patients, although considered in biological remission, and their physicians in 33% of the cases. As previously described 2 , our data seems to confirm that potential causes for this discordance could be pain due to non-inflammatory processes, functional disability and compromised physical health. In the present study also psychological stress, particularly state anxiety, seems to negatively affect PGA/PhGA concordance. These results confirm the importance, in clinical practice, of exploring and managing inflammatory and non-inflammatory parameters separately, also in patients achieving biological remission. References: [1]Svensson B et al. BMJ Open. 2013. 2 Craig ET et al. Arthritis Care Res. 2019. Table 1. Data are expressed as median (1 st -3 rd quartile) and compared using Mann-Whitney test. PATIENT-REPORTED OUTCOMEs PATIENT NUMBER =90 CONCORDANT GROUP (PGA-PhGA) &lt;30 =60 (67% ) DISCORDANT GROUP (PGA-PhGA) ≥30 =30 (33% ) p &lt;0,05 PGA, [0-100] 20 (10-40) 10 (0-20) 50 (37-60) - PhGA, [0-100] 0 (0-10) 0 (0-10) 10 (0-10) - PGA-PhGA, [0-100] 10 (0-30) 10 (0-10) 40 (30-52) - VAS pain, [0-100] 20 (10-40) 10 (0-20) 50 (30-60) &lt;0,001 HAQ, [0-3] 0,13 (0-0,50) 0 (0-0,25) 0,31 (0,09-0,87) &lt;0,001 STAI Y1, [20-80] 36 (31-47) 35 (30-42) 40 (35-51) 0,014 STAI Y2, [20-80] 37 (33-45) 37 (33-45) 38 (33-47) ns SDS ZUNG, [25-100] 45 (40-51) 44 (39-49) 48 (40-53) ns ISI, [0-28] 2 (2-11) 5 (2-11) 8 (3-14) ns SF36 Physical, [0-100] 44 (36-52) 48 (40-54) 36 (28-46) &lt;0,001 SF36 Mental, [0-100] 50 (38-56) 51 (41-57) 47 (33-54) ns Disclosure of Interests: None declared