Joan and Sanford Weill Medical College of Cornell University, Hospital for Special Surgery, New York, NY 10221, USA.
J Clin Rheumatol. 2013 Sep;19(6):317-23. doi: 10.1097/RHU.0b013e3182a2164f.
In rheumatoid arthritis (RA), there is discordance between patient and physician assessments of disease severity and treatment response.
This retrospective analysis of the RADIUS (RA Disease-Modifying Anti-Rheumatic Drug Intervention and Utilization Study) 1 cohort examined specific factors that influence differences in global assessments for therapeutic effectiveness of disease-modifying antirheumatic drugs made by physicians (physician global assessment [PhGA]) and patients (patient global assessment [PtGA]).
The RADIUS 1 cohort consisted of primarily community-based private practice patients with RA requiring either the addition of or a switch to a new biologic or nonbiologic disease-modifying antirheumatic drug and who were followed for up to 5 years by their rheumatologists. Periodic assessments included PhGA, PtGA, Health Assessment Questionnaire-Disability Index (HAQ-DI), 28-item tender/painful joint count (TJC28), swollen joint count (SJC28), pain Visual Analog Scale (VAS), and acute-phase reactants.
Among 4359 patients (mean disease duration, 7.3 years), PhGA most highly correlated with TJC28 (0.6956; 95% confidence interval [CI], 0.6881-0.7030) and SJC28 (0.6757; 95% CI, 0.6678-0.6834). Moderate overall correlations were observed for PtGA with TJC28 (0.5000; 95% CI, 0.4890-0.5108) and less 50 with SJC28 (0.3754; 95% CI, 0.3628-0.3878). Patient global assessment most strongly correlated with pain VAS (0.8349; 95% CI, 0.8305-0.8392) and moderately correlated with HAQ-DI (0.5979; 95% CI, 0.5886-0.6071). Acute-phase reactants poorly correlated with PhGA and PtGA.
Low correlations between PhGA and acute-phase reactants suggest that these measurements have a limited contribution compared with the physical examination when physicians make global assessments. These results also suggest that physicians should consider patients' assessments of their disease activity (HAQ, pain VAS, and PtGA) and put joint counts into proper context.
在类风湿关节炎（RA）中，患者和医生对疾病严重程度和治疗反应的评估存在差异。
本研究对 RADIUS（RA 疾病修饰抗风湿药物干预和利用研究）1 队列进行了回顾性分析，旨在探讨影响医生（医生整体评估[PhGA]）和患者（患者整体评估[PtGA]）对疾病修饰抗风湿药物治疗效果的整体评估差异的具体因素。
RADIUS 1 队列由主要来自社区私人执业的 RA 患者组成，这些患者需要添加或转换为新的生物或非生物疾病修饰抗风湿药物，他们的风湿病医生对其进行了长达 5 年的随访。定期评估包括 PhGA、PtGA、健康评估问卷残疾指数（HAQ-DI）、28 个关节压痛/疼痛计数（TJC28）、肿胀关节计数（SJC28）、疼痛视觉模拟量表（VAS）和急性相反应物。
在 4359 名患者（平均疾病持续时间 7.3 年）中，PhGA 与 TJC28（0.6956；95%置信区间[CI]，0.6881-0.7030）和 SJC28（0.6757；95%CI，0.6678-0.6834）的相关性最高。PtGA 与 TJC28（0.5000；95%CI，0.4890-0.5108）和 SJC28（0.3754；95%CI，0.3628-0.3878）的相关性中等。PtGA 与疼痛 VAS（0.8349；95%CI，0.8305-0.8392）的相关性最强，与 HAQ-DI（0.5979；95%CI，0.5886-0.6071）的相关性中等。急性反应物与 PhGA 和 PtGA 的相关性较差。
PhGA 与急性反应物之间的低相关性表明，与体格检查相比，这些测量方法对医生进行整体评估的贡献有限。这些结果还表明，医生应考虑患者对其疾病活动的评估（HAQ、疼痛 VAS 和 PtGA），并将关节计数置于适当的背景下。
