Background:Patient’s Global Assessment of Disease Activity (PtGA) and Physician’s Global Assessment of Disease Activity (PhGA) are important measures in the evaluation of patients with Spondyloarthritis (SpA), but often provide discordant results.1Both PtGA and PhGA are assessed as part of ankylosing spondylitis disease activity score (ASDAS), that is a measure of axial SpA disease activity endorsed by the Assessment of SpA International Society (ASAS) and Outcome Measures in Rheumatology.2,3In peripheral SpA, although there are no formally validated indexes, the American College of Rheumatology (ACR) and Disease Activity Score 28 (DAS 28) response criteria have shown reliable discriminant characteristics and both include PtGA and PhGA.3The lack of concordance between PtGA and PhGA may mislead treatment decisions, namely switches.Objectives:To assess the determinants of patient-physician discordance in SpA patients under biologic treatment.Methods:Cross-sectional study, including 72 with SpA according ASAS criteria. Physicians’ evaluation included comorbidities, parameters of inflammatory activity (erythrocyte sedimentation rate [ESR] and C-reactive protein [CRP], PhGA, ASDAS PCR and, DAS 28, and Participants completed patient-reported outcomes (PROs) and sociodemographic characteristics. For statistical analysis, SPSS was used and significance level was 2-sided p<0.05.Results:Clinical and laboratory characteristics of patients are shown in table 1. PtGA and PhGA were significantly different (34.8±21.2vs7.8±12.5 mm, respectively, p< .001) and patient-physician discordance (ΔPtGA - PhGA) was 27.5±14.3 mm.In peripheral SpA, patient-physician discordance had a correlation with patient age, Health Assessment Questionnaire (HAQ), Functional Assessment of Chronic Illness Therapy (FACIT), EuroQol-5 dimension (EQ5D), Short Form (36) Health Survey (SF-36), Hospital Anxiety and Depression scales (HADS), CRP, ESR, number of comorbidities and daily medication, and an association with employment status (employees had lesser discordance), anxiety/depression, fibromyalgia and osteoarthritis (OA). In multivariable analysis including employment status, SF-36, OA, number of comorbidities, and ESR (R2adjusted= .505), the main predictors of patient-physician discordance were lower SF36, higher number of comorbidities and employment status.In axial SpA, patient-physician discordance had a correlation with nocturnal back pain and total back pain VAS, FACIT, EQ5D, SF-36, HADS, Bath Ankylosing Spondylitis Functional Index (BASFI) and Bath Ankylosing Spondylitis Activity Index (BASDAI) scales, age, number of comorbidities and daily medication and an association with employment status (employees had lesser discordance), anxiety/depression and fibromyalgia. In multivariable analysis including employment status, SF-36, fibromyalgia, and number of comorbidities (R2adjusted= .738), the main predictors of patient-physician discordance were lower SF36, higher number of comorbidities and concomitant diagnosis of fibromyalgia.Neither for peripheral SpA nor for axial SpA an association with SpA subtype, HLA-B27 positivity, patient or physician gender, or patient education level was found.Conclusion:This study shows the variability implied in patient-physician discordance. We have demonstrated that comorbidities, employment status, and other factors not directly related to the disease are determinants for the patient-physician discordance.References:[1]Desthieux C, et al. 2016[2]Machado P et al. 2013[3]Mease PJ. 2011Disclosure of Interests:None declared
BackgroundA BASDAI ≥4 has been often required to start TNFi therapy in patients with axSpA. However, this cut-off of high disease activity (HDA) is largely arbitrary. Unlike BASDAI, ASDAS incorporates objective measures (e.g. CRP) and has a validated definition of HDA (≥2.1). It has thus been suggested that ASDAS could also be used to guide treatment decisions, but evidence to support this is still scarce.ObjectivesTo compare the impact of applying the ASDAS and BASDAI definitions of HDA in selecting patients for TNFi-treatment in daily clinical practiceMethodsPatients from Reuma.pt (Rheumatic Diseases Portuguese Register), with diagnosis of axSpA according to their rheumatologists (both treated and not treated with their first TNFi), with complete baseline BASDAI and ASDAS data, and complete 6 month of follow-up (i.e. baseline, 3 and 6 months visits available) were included. Four subgroups [cross-tabulation between ASDAS (≥2.1) and BASDAI (≥4) definitions of HDA], were compared according to baseline demographic and clinical characteristics in the ‘eligible population’ (i.e. irrespective of TNFi-treatment). In addition, for patients starting TNFi and with complete follow-up BASDAI/ASDAS data (‘efficacy population’), the subgroups were also compared according to different response criteria (see table 1), at 3 and 6 months.ResultsIn total, 466 patients were included (59% males and 66% HLA-B27 positive). The large majority (n=382; 82%) fulfilled the definition of HDA according to both BASDAI and ASDAS at baseline (i.e. BASDAI≥4 and ASDAS≥2.1). The frequency of ASDAS≥2.1, if BASDAI<4, was much higher than the opposite condition (i.e. ASDAS<2.1, if BASDAI≥4) (70% vs 0.5%). Compared to patients fulfilling both definitions, those who were ASDAS≥2.1 only, were more likely to be male (82.5% vs 54%), HLA-B27 positive (79% vs 54%), to show higher levels of CRP (2.6±2.5 vs 2.2±2.8 mg/dL) and lower BASFI (3.1±2.6 vs 5.6±2.3). In the ‘efficacy population’ (n=296), better responses were observed among patients with ASDAS≥2.1 only, especially for the most ’stringent’ outcomes [e.g. ASDAS inactive disease (ASDAS ID): 59% and 50%, at 3 and 6 months respectively], compared to patients fulfilling both definitions (ASDAS ID: 26% and 25% at 3 and 6 months respectively) (table 1).Abstract SAT0260 – Table 1TNFi response criteria across subgroups according to BASDAI/ASDAS category (‘efficacy population’)ConclusionsOur results show that the ASDAS-HDA definition (ASDAS≥2.1) is more inclusive than the BASDAI-HDA definition (≥4) in selecting axSpA patients for TNFi treatment. Importantly, the additionally ‘captured’ patients respond better and have higher likelihood of predictors thereof. These results support the use of ASDAS≥2.1 as a selection criterion for treatment decisions.AcknowledgementsSupported in part by a research Grant from Investigator-Initiated Studies program of MSD Disclosure of InterestJ. Marona Grant/research support from: MSD, A. Sepriano Grant/research support from: MSD, S. Rodrigues-Manica Grant/research support from: MS...
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