Factors associated with patient-physician discordance in a prospective cohort of patients with psoriatic arthritis: An Asian perspective.

objectivesTo evaluate factors associated with patient-physician discordance in a multiethnic Asian cohort of psoriatic arthritis (PsA) patients.

methodsWe used data from a prospective cohort of consecutive patients with PsA fulfilling the Classification Criteria for Psoriatic Arthritis, recruited from a single center in Singapore. Sociodemographic, clinical data and patient-reported outcomes were collected using a standardized protocol at baseline, 4 months, 8 months, 1 year, 2 years and 5 years. patient-physician discordance was defined as patient global assessment minus physician global assessment (PGA-PhGA). We evaluated variables associated with patient-physician discordance using generalized linear regression to control for within-subject effect.

resultsOne hundred and fortytwo patients (51.4% male, 66.2% Chinese, mean [SD] age and duration of illness 51.1 [13.8] years and 27.5 [98.3] months) were recruited at baseline. Paired results for PGA and PhGA were available for 291 visits with median (interquartile range) follow-up time of 11.6 (17) months. In univariable analysis, duration of illness, fatigue, pain, tender and swollen joint count, dactylitis count, and health-related quality of life (Short Form-36) domains were significantly correlated with patient-physician discordance. In multivariable analysis, age, fatigue level, pain score were positively associated with patient-physician discordance, while swollen joint count and mental health were negatively associated with patient physician discordance.

conclusionsIncreased age, higher fatigue levels, higher pain score  and poorer mental health may explain underestimation of disease activity by physicians. Physicians' overestimation of disease activity may be explained by higher swollen joint counts.