Jennifer Barton|John B. Imboden|Jonathan Graf|David V. Glidden|Edward H. Yelin|Dean Schillinger
Patient?physician discordance in assessments of global disease severity in rheumatoid arthritis
University of California, San Francisco|University of California, San Francisco|University of California, San Francisco|University of California, San Francisco|University of California, San Francisco|University of California, San Francisco
abstract objective determine degree discordance patient physician assessment disease severity multiethnic cohort adults rheumatoid arthritis ra explore predictors discordance examine impact discordance disease activity score 28 joints das28 methods adults ra n 223 rheumatologists completed visual analog scale vas global disease severity independently patient demographics 9item patient health questionnaire phq9 depression scale score health assessment questionnaire score das28 also collected logistic regression analyses used identify predictors positive discordance defined patient rating minus physician rating gt25 mm 100mm vas considered clinically relevant das28 scores stratified level discordance compared using paired test results positive discordance found 30 cases mean sd difference 46 15 strongest independent predictor discordance 5point increase phq9 score adjusted odds ratio 161 95 confidence interval 102255 higher swollen joint count cantonesemandarin language associated lower odds discordance das28 scores divergent among subjects discordance conclusion nearly onethird ra patients differed physicians meaningful degree assessment global disease severity higher depressive symptoms associated discordance investigation relationships mood disease activity discordance may guide interventions improve care adults ra