Discordance between patient and physician global assessment of disease activity in Behcet's syndrome: a multicenter study cohort
Open Access
- 25 December 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in Arthritis Research & Therapy
- Vol. 22 (1), 1-7
- https://doi.org/10.1186/s13075-020-02362-1
Abstract
Background To compare the patients' and physician's global assessment of disease activity in Behcet's syndrome (BS) and investigate the frequency, magnitude, and determinants of potential discordance. Methods A total of 226 adult BS patients with a median (IQR) age of 46.9 (35.6-55.2) years were enrolled across Italy, Greece, Portugal, and Spain. Demographic, clinical, and therapeutic variables, as well as the patient reported outcomes, were collected at the recruitment visit. The physical (PCS) and mental (MCS) component summary scores of the Short Form Questionnaire 36 (SF-36) and the Behcet's syndrome Overall Damage Index (BODI) were calculated. Disease activity was assessed by the patients' (PtGA) and physician's global assessment (PGA) in a 10-cm visual analog scale, as well as the Behcet Disease Current Activity Form (BDCAF). Discordance ( increment ) was calculated by subtracting the PGA from the PtGA and defined as positive (PtGA>PGA) and negative (PtGA 80%) of disagreements were due to patients rating higher their disease activity. Higher values of BDCAF were associated to increased rate of positive discordance. When BDCAF = 0, the median (IQR) values of PtGA and PGA were 0.2 (0-2) and 0 (0-1), respectively. PCS (adjusted odds ratio (adjOR) 0.96 per unit, 95% CI 0.93-0.98, p = 0.006) and MCS (adjOR 0.96 per unit, 95% CI 0.93-0.99, p = 0.003) were independently associated with positive discordance using both cutoffs. Active ocular involvement emerged as a potential determinant of negative discordance (adjOR 5.88, 95% CI 1.48-23.30, p = 0.012). Conclusions PtGA and PGA should be considered as complementary measures in BS, as patients and physicians may be influenced by different factors when assessing active disease manifestations. Particularly, PtGA may be a useful tool in the assessment of BS disease activity, as it carries a low risk to misclassify an inactive disease, and may allow to capture aspects of the patient's health that negatively affect his well-being and the treatment.Funding Information
- Associazione Italiana Sindrome e Malattia di Behçet (SIMBA) - Onlus
This publication has 22 references indexed in Scilit:
- Discordance of Global Assessments by Patient and Physician Is Higher in Female than in Male Patients Regardless of the Physician’s Sex: Data on Patients with Rheumatoid Arthritis, Axial Spondyloarthritis, and Psoriatic Arthritis from the DANBIO RegistryThe Journal of Rheumatology, 2015
- The origin of Behçet's disease geoepidemiology: possible role of a dual microbial-driven genetic selection.2014
- Discrepancies between patients and physicians in their perceptions of rheumatoid arthritis disease activityArthritis & Rheumatism, 2012
- Diagnosis/Classification Criteria for Behcet's DiseasePathology Research International, 2011
- Genetic susceptibility to Behcet's disease: role of genes belonging to the MHC regionRheumatology, 2010
- Patient‐physician discordance in assessments of global disease severity in rheumatoid arthritisArthritis Care & Research, 2010
- Sources of discrepancy in patient and physician global assessments of rheumatoid arthritis disease activity.2004
- Determinants of discordance between patients and physicians in their assessment of lupus disease activity.2003
- SF-36 Health Survey UpdateSpine, 2000
- The influence of patient-practitioner agreement on outcome of care.American Journal of Public Health, 1981