Discordance between physician's and parent's global assessments in juvenile idiopathic arthritis

Abstract

Objective . To investigate the discrepancy between physician's and parent's global assessments of disease status and the factors explaining discordance in patients with juvenile idiopathic arthritis (JIA). Methods . The mothers of 197 patients with JIA rated the child's overall well-being on a 10 cm visual analogue scale (VAS) and the attending physician rated the child's overall disease activity on a 10 cm VAS. A discordance score was calculated by subtracting the physician's global assessment from that of the parent's, leading to the definition of three patient groups: (1) no discordance, when physician's and parent's assessments were within 1 cm of each other; (2) negative discordance, when parent's assessment was underrated relative to the physician; and (3) positive discordance, when parent's assessment was over-rated relative to the physician. Negative and positive discordance was defined as ‘marked’ when the difference between the two assessments was greater than 3 cm. Results . No discordance was found in 40.6% of the patients. Negative discordance was found in 51.3% of the patients, with 34% showing marked discordance. Positive discordance was found in 8.1% of the patients, with 2% showing marked discordance. Significant differences between groups included a shorter disease duration among patients with a markedly positive discordance ( P = 0.02) and a greater frequency of ongoing second-line drug therapy among patients with no discordance or with positive discordance ( P = 0.008). Patients with no discordance or with marked positive discordance had a significantly lower joint counts ( P = 0.02–0.004). Conclusion . Parents and physicians often perceive the health status of children with JIA differently, with parents providing most frequently lower rating.