Factors Explaining the Discrepancy Between Physician and Patient Global Assessment of Joint and Skin Disease Activity in Psoriatic Arthritis Patients

Eder, Lihi; Thavaneswaran, Arane; Chandran, Vinod; Cook, Richard J.; Gladman, Dafna D.

doi:10.1002/acr.22401

Cited by 75 publications

(87 citation statements)

References 20 publications

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“…Our findings are consistent with prior smaller single-center studies that assessed factors that may influence the differences in patient-physician alignment with regard to PsA activity and control [11,18,19]. Previous studies found that patients with PsA experience a more severe burden of disease than that perceived by the physician [11,18], and nearly one quarter to a third of patients with PsA were misaligned with their physicians [11].…”

Section: Discussionsupporting

confidence: 90%

“…The earlier studies found greater misalignment regarding the perception of disease activity in the joints than that of the skin symptoms (i.e., TJC, SJC vs. psoriasis, etc.) [11,18,19], possibly indicating that skin lesions are more obvious and easily perceived, so are easier to Balign^ [19]. In previous PsA studies, factors associated with misalignment were SJC, TJC, pain, and fatigue [11,18,19].…”

Section: Discussionmentioning

confidence: 95%

“…Previous studies found that patients with PsA experience a more severe burden of disease than that perceived by the physician [11,18], and nearly one quarter to a third of patients with PsA were misaligned with their physicians [11]. The earlier studies found greater misalignment regarding the perception of disease activity in the joints than that of the skin symptoms (i.e., TJC, SJC vs. psoriasis, etc.)…”

Section: Discussionmentioning

confidence: 98%

“…The assessment of disease activity in PsA relies partially on patient-reported outcomes in combination with clinical and laboratory evaluation by the physician [11,12]. Alignment between physicians and patients with respect to PsA activity is important for the optimal implementation of a treatment plan and to promote the most effective outcome for patients [13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

“…Findings from these studies suggest a significant disconnection in the manner in which PsA patients and their rheumatologists define and report PsA activity and control [11,18,19]. Currently available data also indicate low patient satisfaction with care among some patients with PsA and has been associated with a lack of psychological support and knowledge about PsA and treatment [20].…”

Section: Introductionmentioning

confidence: 99%

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Misalignment between Physicians and Patient Satisfaction with Psoriatic Arthritis Disease Control

Fürst

Tran

Sullivan

et al. 2016

Rheumatology (Sunnyvale)

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The main objective of the present study is to evaluate the misalignment between psoriatic arthritis (PsA) patient-and physician-reported satisfaction with PsA control. Data came from the Adelphi Rheumatology Disease Specific Programme, a retrospective, cross-sectional survey of USbased rheumatologists and patients. Physicians provided satisfaction and clinical characteristics on tender joint count, swollen joint count, and percent body surface area (BSA) affected by psoriasis. Patients provided data on satisfaction, the Work Productivity Activity Impairment and Health Assessment Questionnaire-Disability Index (HAQ-DI) questionnaires. Based on their satisfaction response, patient-physician pairs were classified into aligned (both satisfied or dissatisfied) or misaligned (rated satisfaction differently) groups. Multivariate analysis evaluated association of characteristics with misalignment. Among 305 paired patient-physician records analyzed, 23.6% were misaligned and 76.4% were aligned. The misaligned group had shorter disease duration (mean years, 5.2 vs. 6.4), used fewer biologic disease-modifying antirheumatic drugs (49.3 vs. 62.9%), had more swollen (mean, 3.7 vs. 1.9, P = 0.0002) and tender joints (mean, 5.6 vs. 2.9, P < 0.0001), greater proportion of patients with comorbidities (72.2 vs. 63.1%), and >3% BSA affected by psoriatic skin lesions (64.2 vs. 55.1%). Misaligned patients reported greater work impairment (mean, 38.7 vs. 21.4, P = 0.0004), daily activities (mean, 38.7 vs. 22.3, P < 0.0001), and higher disease burden (mean HAQ-DI; 0.56 vs. 0.37, P = 0.0001). Multivariate analysis found the number of swollen joints (P = 0.02) and HAQ-DI score (P = 0.03) was significantly associated with misalignment among all patients; however, not in the subgroup of employed patients. Patient-physician misalignment is associated with increased disease activity and disability among patients with PsA.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Misalignment between Physicians and Patient Satisfaction with Psoriatic Arthritis Disease Control

Fürst

Tran

Sullivan

et al. 2016

Rheumatology (Sunnyvale)

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Association of Patient Mental Health Status With the Level of Agreement Between Patient and Physician Ratings of Psoriasis Severity

et al. 2021

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The emerging paradigm of treat-to-target in psoriasis requires accurate monitoring of treatment response. The commonly used physician global assessment tool does not capture the patient's perception of their disease. Patient assessments facilitate shared decision-making and foster patient-centered care; however, recent research reports a discordance between patient-and physician-reported psoriasis severity. Understanding the factors underlying this discordance may improve treatment satisfaction and disease outcomes.OBJECTIVES To evaluate the discordance between patient-and physician-reported measures of psoriasis severity and assess the association with patient mental health status. DESIGN, SETTING, AND PARTICIPANTSA cohort study using repeated cross-sectional analysis of real-world longitudinal data was conducted at a large specialist psoriasis service serving London and Southeast England. A total of 502 patients attending the psoriasis service between May 12, 2016, and November 1, 2018, were included. Data analysis was conducted July 22 to October 22, 2019.MAIN OUTCOMES AND MEASURES Psoriasis severity was assessed on each visit with identical 5-point physician and patient global assessment scales (clear/nearly clear, mild, moderate, severe, and very severe). Each patient completed validated self-report screens for depression and anxiety on each visit. RESULTSLongitudinal data from 502 individuals with psoriasis (1985 total observations) were available. A total of 339 patients (68%) were men, 396 (79%) were White, mean (SD) age was 47 (13) years, and 197 patients (39%) had concurrent psoriatic arthritis, 43 (9%) screened positive for depression, and 49 (10%) screened positive for anxiety. There was discordance between physician and patient measures of disease severity in 768 of 1985 office appointments (39%); on 511 visits (26%) patients rated their psoriasis as less severe and on 257 visits (13%) patients rated their psoriasis as more severe compared with their physician. Individuals who screened positive for depression or anxiety were more likely to overestimate their psoriasis severity compared with their physician (relative risk ratio: depression, 2.7; 95% CI, anxiety, 2.1; 95% CI,). These findings remained statistically significant after adjustment for age, ethnicity, sex, body mass index, smoking, number of comorbidities, treatment modality, and presence of psoriatic arthritis. CONCLUSIONS AND RELEVANCEThe findings of this cohort study suggest that discordance between patient and physician assessments of psoriasis severity is associated with patients' mental health status. Recognition of anxiety and depression in individuals with psoriasis appears to be important when interpreting patient-reported outcome measures and informing appropriate treatment decisions.

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Understanding Discordant Perceptions of Disease Severity Between Physicians and Patients With Eczema and Psoriasis Using Structural Equation Modeling

Long

Chan

et al. 2023

JAMA Dermatol

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ImportancePatients and physicians often have differing opinions on the patient’s disease severity. This phenomenon, termed discordant severity grading (DSG), hinders the patient-physician relationship and is a source of frustration.ObjectiveTo test and validate a model explaining the cognitive, behavioral, and disease factors associated with DSG.Design, Setting, and ParticipantsA qualitative study was first performed to derive a theoretical model. In this subsequent prospective cross-sectional quantitative study, the qualitatively derived theoretical model was validated using structural equation modeling (SEM). Recruitment was conducted between October 2021 and September 2022. This was a multicenter study in 3 Singapore outpatient tertiary dermatological centers. Dermatology patients and their attending physicians were recruited by convenience sampling. Patients were aged 18 to 99 years with psoriasis or eczema of at least 3 months’ duration and recruited only once. The data were analyzed between October 2022 to May 2023.Main Outcomes and MeasuresThe outcome was the difference between global disease severity (0-10 numerical rating scale with a higher score indicating greater severity) as independently scored by the patient and the dermatologist. Positive discordance was defined as patient-graded severity more than 2 points higher (graded more severely) than physicians, and negative discordance if more than 2 points lower than physicians. Confirmatory factor analysis followed by SEM was used to assess the associations between preidentified patient, physician, and disease factors with the difference in severity grading.ResultsOf the 1053 patients (mean [SD] age, 43.5 [17.5] years), a total of 579 (55.0%) patients were male, 802 (76.2%) had eczema, and 251 (23.8%) had psoriasis. Of 44 physicians recruited, 20 (45.5%) were male, 24 (54.5%) were aged between 31 and 40 years, 20 were senior residents or fellows, and 14 were consultants or attending physicians. The median (IQR) number of patients recruited per physician was 5 (2-18) patients. Of 1053 patient-physician pairs, 487 pairs (46.3%) demonstrated discordance (positive, 447 [42.4%]; negative, 40 [3.8%]). Agreement between patient and physician rating was poor (intraclass correlation, 0.27). The SEM analyses showed that positive discordance was associated with higher symptom expression (standardized coefficient B = 0.12; P = .02) and greater quality-of-life impairment (B = 0.31; P &lt; .001), but not patient or physician demographics. A higher quality-of-life impairment was in turn associated with lower resilience and stability (B = −0.23; P &lt; .001), increased negative social comparisons (B = 0.45; P &lt; .001), lower self-efficacy (B = −0.11; P = .02), increased disease cyclicity (B = 0.47; P &lt; .001), and greater expectation of chronicity (B = 0.18; P &lt; .001). The model was well-fitted (Tucker-Lewis: 0.94; Root Mean Square Error of Approximation: 0.034).Conclusions and RelevanceThis cross-sectional study identified various modifiable contributory factors to DSG, increased understanding of the phenomenon, and set a framework for targeted interventions to bridge this discordance.

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Factors Explaining the Discrepancy Between Physician and Patient Global Assessment of Joint and Skin Disease Activity in Psoriatic Arthritis Patients

Abstract: Fatigue, pain, disability, and tender and swollen joint counts were the most important factors contributing to discrepancy between patient and physician assessment of joint activity.

Cited by 75 publications

References 20 publications

Misalignment between Physicians and Patient Satisfaction with Psoriatic Arthritis Disease Control

Misalignment between Physicians and Patient Satisfaction with Psoriatic Arthritis Disease Control

Association of Patient Mental Health Status With the Level of Agreement Between Patient and Physician Ratings of Psoriasis Severity

Understanding Discordant Perceptions of Disease Severity Between Physicians and Patients With Eczema and Psoriasis Using Structural Equation Modeling

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