Lack of agreement between patients' and physicians' perspectives of rheumatoid arthritis disease activity changes
Lack of agreement between patients' and physicians' perspectives of rheumatoid arthritis disease activity changes
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DOI：
10.1080/03009740600906727
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发表时间：
2006-01-01
影响因子：
2.1
通讯作者：
Rintelen, B.
中科院分区：
文献类型：
--
作者：
Leeb, B. F.;Sautner, J.;Rintelen, B.
目的：为了获得信息的变化，患者的满意度（PATSAT）和医生的全球评估（PhGASS）方面的类风湿关节炎（RA）的活动volumets.Methods：88 RA门诊患者的207调查进行了评估，平均3个月后的初步评价。在首次评价时评估PATSAT（1 =优秀至5 =不满意）、PhGASS（视觉模拟量表1 - 100）和28关节疾病活动评分（DAS 28）。入组的唯一先决条件是首次访视时的任何治疗变化。对PATSAT（SATCH）和PhGASS（PhGACH）的变化进行分类，随后与DAS 28变化相关。结果：为了获得阳性SATCH（n=26/88例患者），必须使DAS 28中位数降低-1.06（-25.0%），而相当低的中位数增加+0.16（+10.5%）会导致阴性SATCH。PhGASS（n = 38/88例患者）在中位DAS 28降低-0.82（-16.0%）时发生积极变化，而在平均DAS 28增加+0.55（+16.5%）时恶化。可以观察到SATCH和PhGACH之间约60%的一致性（kappa=0.139）。SATCH和PhGACH阳性前的DAS 28值显著高于阴性变化前（p < 0.001）。结论：患者对RA改善或恶化的看法是不对称的。与医生的观点相反，患者需要更大的改善才能感到满意，需要更少的恶化才能感到不满意。这些结果可能提供额外的指导，在考虑有关定义的反应和非反应在RA。
Objective: To obtain information on changes in patients' satisfaction (PATSAT) and physicians' global assessment (PhGASS) with regard to rheumatoid arthritis (RA) activity fluctuations.Methods: Eighty-eight RA outpatients out of 207 investigated were assessed for 3 months on average after the initial evaluation. PATSAT (1 = excellent to 5 = unsatisfactory), PhGASS (visual analogue scale 1 - 100), and the 28-joint Disease Activity Score (DAS28) were assessed as at the first evaluation. The only prerequisite for enrolment was any therapeutic change at the first visit. Changes in PATSAT (SATCH) and PhGASS (PhGACH) were categorized and subsequently related to the DAS28 changes. Statistical evaluation was carried out by the Kruskal-Wallis test, the Mann-Whitney U-test, and by kappa statistics.Results: To achieve a positive SATCH (n=26/88 patients), a median DAS28 reduction of -1.06 (-25.0%) was necessary, whereas a considerably lower median increase of +0.16 (+10.5%) caused a negative SATCH. PhGASS (n = 38/88 patients) changed positively on a median DAS28 reduction of -0.82 (-16.0%), whereas it worsened at a mean DAS28 increase of +0.55 (+16.5%). Approximately 60% congruence between SATCH and PhGACH could be observed (kappa=0.139). The DAS28 values preceding a positive SATCH and PhGACH were significantly higher (p < 0.001) than before a negative change.Conclusion: The patients' perspective with respect to improvement or worsening of RA is asymmetric. In contrast to the physicians' perspective, patients require greater improvement to be satisfied and less deterioration to be dissatisfied. These results may provide additional guidance in considerations about defining response and non-response in RA.