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Discordance of global assessment by patients and physicians is higher in osteoarthritis than in rheumatoid arthritis: a cross-sectional study from routine care

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Abstract

The study compares patient–physician discordance in global assessment in patients with osteoarthritis (OA) versus patients with rheumatoid arthritis (RA) seen in routine care. This is a cross-sectional study conducted at an academic rheumatology center at which all patients are asked to complete a Multi-Dimensional Health Assessment Questionnaire (MDHAQ), which includes a patient global assessment (PATGL). Rheumatologists are encouraged to complete a physician questionnaire, which includes a physician global assessment (DOCGL). Patients with either OA or RA were identified using ICD9 codes and classified as positive discordance (PATGL-DOCGL ≥ 2), negative discordance (PATGL-DOCGL≤ − 2), and concordance (absolute difference between the two assessments < 2). Discordance was assessed by diagnosis. Agreement between patient and physician global assessments was evaluated using intraclass correlations. Logistic regression was performed to identify explanatory variables for positive discordance. The analysis included 243 OA and 216 RA patients. Mean PATGL was higher in OA versus RA (5.4 versus 4.2, p = 0.005), while mean DOCGL was similar (4.0 versus 3.8, p = 0.23) leading to a higher patient–physician discordance in OA (1.35 versus 0.43, p < 0.001). Positive discordance occurred in 34% of OA versus 18% of RA patients (p < 0.001). Intraclass correlation coefficients were 0.43 in OA versus 0.60 in RA patients. In logistic regressions, pain was the only statistically significant explanatory variable for discordance in both OA (OR 1.34, 95% CI 1.12–1.78) and RA (OR 1.47 95% CI 1.04–2.07). Patients with OA are more likely to be discordant with their rheumatologists than patients with RA because of a higher PATGL. Similarly to RA, the most important explanatory variable for discordance was higher pain.

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Acknowledgements

We thank all patients, rheumatologists, nurses, and front desk personnel at Rush University Medical Center, who provided or completed the questionnaires and made this study possible. The authors thank Dr. Pincus for helpful discussions.

Funding

This work was supported by internal funding and did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Division of Rheumatology, Rush University Medical Center, 1161 West Harrison Street, Suite 510, Chicago, IL, 60612, USA

    Isabel Castrejon, Najia Shakoor, Jacquelin R. Chua & Joel A. Block

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  1. Isabel Castrejon
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  2. Najia Shakoor
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  3. Jacquelin R. Chua
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Contributions

IC, NS, JRC, JAB conception, design, interpretation of the data, and manuscript preparation including revising it critically for important intellectual content. NS, JRC, JAB: acquisition of data. IC: statistical analysis. All authors approved the final version to be published.

Corresponding author

Correspondence to Isabel Castrejon.

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Conflict of interest

IC declares that she has no conflict of interest. NS declares that she has no conflict of interest. JRC declares that she has no conflict of interest. JAB is a Board of Directors Member of the American College of Rheumatology and the Osteoarthritis Research Society International and has received consulting fees from Zynerba Pharma and Glaxo SmithKline.

Ethical approval

This study was conducted in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 1983. The study was reviewed and approved by the Institutional Review Board at Rush University Medical Center and it received an IRB waiver of patient consent for retrospective use of data up to February 28, 2017 (Rush Rheumatic Diseases Patient Reported Outcomes Studies: 14090502-IRB02-AM03).

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Castrejon, I., Shakoor, N., Chua, J.R. et al. Discordance of global assessment by patients and physicians is higher in osteoarthritis than in rheumatoid arthritis: a cross-sectional study from routine care. Rheumatol Int 38, 2137–2145 (2018). https://doi.org/10.1007/s00296-018-4166-2

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