Determinants of discordance in patients' and physicians' rating of rheumatoid arthritis disease activity.
Determinants of discordance in patients' and physicians' rating of rheumatoid arthritis disease activity.
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DOI：
10.1002/acr.20685
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发表时间：
2012-02
影响因子：
4.7
通讯作者：
Sokka, Tuulikki
中科院分区：
文献类型：
--
作者：
Khan, Nasim A.;Spencer, Horace J.;Abda, Esam;Aggarwal, Amita;Alten, Rieke;Ancuta, Codrina;Andersone, Daina;Bergman, Martin;Craig-Muller, Jurgen;Detert, Jacqueline;Georgescu, Lia;Gossec, Laure;Hamoud, Hisham;Jacobs, Johannes W. G.;Magalhaes Laurindo, Ieda Maria;Majdan, Maria;Naranjo, Antonio;Pandya, Sapan;Pohl, Christof;Schett, Georg;Selim, Zahraa I.;Toloza, Sergio;Yamanaka, Hisahi;Sokka, Tuulikki
评估患者(PTGL)和医生(MDGL)对类风湿关节炎(RA)活动的全球评估的决定因素以及它们之间不协调的相关因素。在定量标准监测类风湿性关节炎患者研究中，共有7,028名患者在同一次临床访问中对PTGL和MDGL进行了0-10厘米视觉模拟评分(VAS)评估。患者分为三组：一致性评定组(PTGL和MDGL在±2 cm以内)、高患者评定组(PTGL比MDGL高2 cm)和低患者评定组(PTGL比MDGL低2 cm)。用多元回归分析确定PTGL和MDGL的决定因素及其不一致性。PTGL和MDGL的平均VAS评分分别为4.01±2.70和2.91±2.37。疼痛是PTGL最重要的单一决定因素，其次是疲劳。MDGL受肿胀关节数(SJC)的影响最大，其次是血沉(ESR)和压痛关节数(TJC)。共有4454名患者(63.4%)、2106名(30%)和468名(6.6%)患者分别属于一致性、较高和较低患者评级组。疼痛、疲劳、心理困扰、年龄和晨僵程度越高，患者评分越高的几率越高，而SJC、TJC和血沉越高，患者评级越高的几率越低。较低的患者分级几率随SJC、TJC和ESR的升高而增加，而随疲劳程度的降低而降低。近36%的患者在医生对RA活动的评估中存在不一致之处。对患者的“疾病经历”，特别是疼痛和疲劳的敏感，是有效护理类风湿关节炎的保证。
To assess the determinants of patients’ (PTGL) and physicians’ (MDGL) global assessment of rheumatoid arthritis (RA) activity and factors associated with discordance among them. A total of 7,028 patients in the Quantitative Standard Monitoring of Patients with RA study had PTGL and MDGL assessed at the same clinic visit on a 0–10-cm visual analog scale (VAS). Three patient groups were defined: concordant rating group (PTGL and MDGL within ±2 cm), higher patient rating group (PTGL exceeding MDGL by >2 cm), and lower patient rating group (PTGL less than MDGL by >2 cm). Multivariable regression analysis was used to identify determinants of PTGL and MDGL and their discordance. The mean ± SD VAS scores for PTGL and MDGL were 4.01 ± 2.70 and 2.91 ± 2.37, respectively. Pain was overwhelmingly the single most important determinant of PTGL, followed by fatigue. In contrast, MDGL was most influenced by swollen joint count (SJC), followed by erythrocyte sedimentation rate (ESR) and tender joint count (TJC). A total of 4,454 (63.4%), 2,106 (30%), and 468 (6.6%) patients were in the concordant, higher, and lower patient rating groups, respectively. Odds of higher patient rating increased with higher pain, fatigue, psychological distress, age, and morning stiffness, and decreased with higher SJC, TJC, and ESR. Lower patient rating odds increased with higher SJC, TJC, and ESR, and decreased with lower fatigue levels. Nearly 36% of patients had discordance in RA activity assessment from their physicians. Sensitivity to the “disease experience” of patients, particularly pain and fatigue, is warranted for effective care of RA.
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影响因子：
3.5
作者：
Diatchenko, L;Slade, GD;Maixner, W
通讯作者：
Maixner, W
影响因子：
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作者：
Aletaha, D.;Funovits, J.;Ward, M. M.;Smolen, J. S.;Kvien, T. K.
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3.9
作者：
Emery, Paul;Genovese, Mark C.;Sasso, Eric H.
通讯作者：
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影响因子：
3.9
作者：
Hirsh, Joel M.;Boyle, Dennis J.;Caplan, Liron
通讯作者：
Caplan, Liron