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Abstract
Purpose In daily clinical practice, it is not rare to observe a relevant discordance between patient’s global assessment (PGA) and physician’s global assessment (PhGA), because of different illness perceptions.
The purpose was to evaluate the presence of PGA/PhGA discrepancy in patients with SLE who were in clinical remission and to evaluate how this discrepancy affects PROs. In addition, to explore whether this discordance could be influenced by the presence of additional elements affecting patients’ quality of life, such as sleep disturbances and psycho-emotional factors.
Methods Our study included adult SLE patients consecutively followed in a single Lupus Clinic from March to July 2021 fulfilling at minimum the definition of clinical remission of treatment according to the definition of Zen et al.1 (cSLEDAI=0, corticosteroids ≤5mg/die, stable dosage of DMARD). Medical records including demographic data, clinical characteristics and outcomes measures were collected. Pain assessment, PGA and PhGA were rated on a visual analogue scale (0–100 mm) on the same day of the clinical evaluation. To analyse the discrepancy between PGA and PhGA, the [PGA-PhGA] variable was calculated, considering as discordant a difference ≥25 mm as previously proposed.2 All the subjects completed the following questionnaires: Health Assessment Questionnaire (HAQ), SF36 Health Survey, State-Trait Anxiety Inventory (STAI-Y1/Y2), Self-rating Depression Scale (SDS Zung) and Insomnia Severity Index (ISI). Statistical analysis was performed to compare concordant and discordant groups.
Results The study included 106 patients, (93 women, 13 men) with a median age of 48 (41–58) and a median SLE duration 227 months (124–330). At the last evaluation median SLEDAI was 0 (0–2) and median SLICC was 1 (0–1). According to Zen definitions of remission, 51 patients (48%) and 20 (19%) also fulfilled the criteria of clinical remission of corticosteroids and complete remission respectively. Nevertheless, in 24 patients (22,7%) [PGA-PhGA]≥25. Patients in the discordant group were older and less frequently achieved the definition of clinical remission of corticosteroids (see table1) than concordant. No differences were found in gender, SLE duration, serology, disease activity or damage and other treatment. Data about differences in PROs between two groups are reported in the Table 1: discordant patients had a worse performance in all the PROs included in the study. At multivariate analysis SF-36 Physical Component Summary (PCS) resulted associated with [PGA-PhGA]≥25 (p=<0,0001).
Data are expressed as absolute number and percentage or median and interquartile range (IQR) and compared using Mann-Whiteney test or Chi Squared test
Conclusions In our study we found that, even in patients considered in remission, in more than 20% of patients there is a considerable discordance between the global disease assessment reported by patients and their physicians. Patients that had a higher PGA also presented worse score at PROs. Our data seems to confirm that potential causes for discordance could be more related to the presence of non-inflammatory processes, depression, or anxiety than clinical manifestations or damage related to SLE.
References
Zen et al. Ann. Rheum. Dis. 2015;74:2117–2122
Neville C, et al. J Rheumatol 2000;27:675–9
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