There is evidence that positive discordance is not associated with unrecognized joint inflammation by ultrasonography and that depression and fibromyalgia appear to play distinct roles in determining positive discordance, according to a recent study that aimed to perform comprehensive clinical evaluation of patient-provider discordance in rheumatoid arthritis (RA).
A cross-sectional observational study was conducted of consecutive RA patients in a regional practice with an absolute difference of ≥25 points between patient and provider global assessments (possible points, 0–100). Data were collected for disease activity measures, clinical characteristics, comorbidities, and medications. In a prospective sub-study, participants completed patient-reported outcome measures and underwent ultrasonographic assessment of synovial inflammation. Researchers found:
- Patient-provider discordance affected 114 (32.5%) of 350 consecutive patients.
- Of the total population, 103 patients (29.5%) rated disease activity higher than their providers (ie, “positive” discordance); only 11 (3.1%) rated disease activity lower than their providers and were excluded from further analysis.
- Positive discordance correlated with negative rheumatoid factor and anticyclic citrullinated peptide antibodies, lack of joint erosions, presence of comorbid fibromyalgia or depression, and use of opioids, antidepressants, or anxiolytics, or fibromyalgia medications.
Challa DN, Kvrgic Z, Cheville AL, et al. Patient-provider discordance between global assessments of disease activity in rheumatoid arthritis: A comprehensive clinical evaluation. [Published online ahead of print September 26, 2017]. Arthritis Res Ther. doi:10.1186/s13075-017-1419-5.
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