ASSESSMENT OF GLOBAL DISEASE ACTIVITY IN RA PATIENTS MONITORED IN THE METEOR DATABASE: THE PATIENT'S VERSUS THE RHEUMATOLOGIST'S OPINION

Background: Disagreement on disease activity between rheumatoid arthritis (RA) patients and rheumatologists may influence treatment decisions and compliance. Objectives: To compare -and identify determinants of- the assessment of disease activity on a visual analogue scale (VAS, 0=best possible, 100=worst possible) by patients (VAS-pt) and physicians (VAS-phy), and to investigate if they are influenced by time. Methods: Anonymous data were used from 2118 Dutch patients included in the METEOR database, a worldwide online tool for disease monitoring in RA. Intra-class correlation coefficients (ICC) were calculated as a measure of agreement and a Bland Altman plot was created to visualize the differences between VAS-pt and VAS-phy. Linear Mixed Model analysis was used to model the VAS-pt and VAS-phy over time. Gender, age, HAQ, swollen joint count, tender joint count, VAS pain, disease duration and BSE were considered as possible determinants of the VAS-pt or VAS-phy. Results: Mean age was 57 years (SD: 15) and 67% of the patients were female. Correlation between VAS-pt and VAS-phy was moderate (ICC 0.61; p<0.01). Patients score on average 11 points higher (worse) than rheumatologists at the first registered visit (95% limits of agreement: -25.2 to 47.6). Scores were increasingly discordant towards the higher end of the scale. Both VAS-phy and VAS pt increase by the tender joint count, HAQ-score and patient's VAS for pain. VAS-phy, but not VAS-pt, also increases by swollen joint count. VAS-phy decreases by disease duration, and VAS-pt showed a similar trend. Table 1. Linear mixed model (LMM) predictors of VAS disease activity by patients and physicians VariablePatient-VASPhysician-VAS Estimate β (95% CI)P valueEstimate β (95% CI)P value Disease duration-0.11 (-0.26, 0.03)0.11-0.30 (-0.48, -0.12)<0.01 SJC280.45 (-0.09, 0.99)0.103.62 (2.59, 4.65)<0.01 TJC280.76 (0.42, 1.09)<0.010.76 (0.14, 1.37)0.02 HAQ3.97 (2.13, 5.81)<0.014.03 (1.04, 7.01)<0.01 VAS pain patient0.55 (0.51, 0.60)<0.010.19 (0.10, 0.27)<0.01 Conclusions: Patients score VAS disease activity systematically higher than rheumatologists, although patients' and physicians' VAS are more or less associated with the same determinants: HAQ-score, tender joint count and VAS pain. But physicians put more weight on swollen joint count, and score lower disease activity over time, whilst patients do not. Disclosure of Interest: None DeclaredCitation: Annals of the Rheumatic Diseases, volume 71, supplement 3, year 2012, page 653Session: Rheumatoid arthritis – prognosis, predictors and outcome (Abstracts accepted for publication )