Abstract | BACKGROUND: In rheumatoid arthritis (RA), there is discordance between patient and physician assessments of disease severity and treatment response. OBJECTIVE: This retrospective analysis of the RADIUS (RA Disease-Modifying Anti-Rheumatic Drug Intervention and Utilization Study) 1 cohort examined specific factors that influence differences in global assessments for therapeutic effectiveness of disease-modifying antirheumatic drugs made by physicians (physician global assessment [ PhGA]) and patients (patient global assessment [PtGA]). METHODS: The RADIUS 1 cohort consisted of primarily community-based private practice patients with RA requiring either the addition of or a switch to a new biologic or nonbiologic disease-modifying antirheumatic drug and who were followed for up to 5 years by their rheumatologists. Periodic assessments included PhGA, PtGA, Health Assessment Questionnaire-Disability Index ( HAQ-DI), 28-item tender/painful joint count (TJC28), swollen joint count (SJC28), pain Visual Analog Scale (VAS), and acute-phase reactants. RESULTS: Among 4359 patients (mean disease duration, 7.3 years), PhGA most highly correlated with TJC28 (0.6956; 95% confidence interval [CI], 0.6881-0.7030) and SJC28 (0.6757; 95% CI, 0.6678-0.6834). Moderate overall correlations were observed for PtGA with TJC28 (0.5000; 95% CI, 0.4890-0.5108) and less 50 with SJC28 (0.3754; 95% CI, 0.3628-0.3878). Patient global assessment most strongly correlated with pain VAS (0.8349; 95% CI, 0.8305-0.8392) and moderately correlated with HAQ-DI (0.5979; 95% CI, 0.5886-0.6071). Acute-phase reactants poorly correlated with PhGA and PtGA. CONCLUSIONS: Low correlations between PhGA and acute-phase reactants suggest that these measurements have a limited contribution compared with the physical examination when physicians make global assessments. These results also suggest that physicians should consider patients' assessments of their disease activity ( HAQ, pain VAS, and PtGA) and put joint counts into proper context.
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Authors | Joseph A Markenson, Andrew S Koenig, Jing Yuan Feng, Sandeep Chaudhari, Debra J Zack, David Collier, Arthur Weaver |
Journal | Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases
(J Clin Rheumatol)
Vol. 19
Issue 6
Pg. 317-23
(Sep 2013)
ISSN: 1536-7355 [Electronic] United States |
PMID | 23965479
(Publication Type: Comparative Study, Journal Article, Multicenter Study, Observational Study, Research Support, Non-U.S. Gov't)
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Chemical References |
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Topics |
- Adult
- Aged
- Antirheumatic Agents
(therapeutic use)
- Arthritis, Rheumatoid
(drug therapy, epidemiology)
- Cohort Studies
- Disability Evaluation
- Female
- Humans
- Male
- Middle Aged
- Pain Measurement
- Patient Outcome Assessment
- Patient Satisfaction
- Patients
- Physicians
- Prospective Studies
- Retrospective Studies
- Surveys and Questionnaires
- Treatment Outcome
- United States
(epidemiology)
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