在较富裕的国家，尽管患者的客观疾病活动评估较低，但他们认为疾病的影响更差：来自横断面 COMORA 研究的结果。

In wealthier countries, patients perceive worse impact of the disease although they have lower objectively assessed disease activity: results from the cross-sectional COMORA study.

机构信息

Rheumatology, Maastricht University Medical Center, CAPHRI, Maastricht, The Netherlands Health Promotion, Maastricht University, CAPHRI, Maastricht, The Netherlands.

Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.

出版信息

Ann Rheum Dis. 2016 Apr;75(4):715-20. doi: 10.1136/annrheumdis-2015-207738. Epub 2015 Aug 27.

DOI:10.1136/annrheumdis-2015-207738

PMID:26314921

Abstract

OBJECTIVES

To investigate patterns in patient-reported and physician-reported disease outcomes in patients with rheumatoid arthritis (RA) from countries with different level of socioeconomic development.

METHODS

Data from a cross-sectional multinational study (COMOrbidities in RA) were used. Contribution of socioeconomic welfare (gross domestic product (GDP); low vs high) of country of residence to physician-reported (tender joint count, swollen joint count (SJC), erythrocyte sedimentation rate, disease activity score based on 28 joints assessment (DAS28)-3v based on these three components and physician global assessment) and patient-reported (modified Health Assessment Questionnaire (mHAQ), patient global assessment and fatigue) disease outcomes was explored in linear regressions, adjusting for relevant confounders.

RESULTS

In total, 3920 patients with RA from 17 countries (30 to 411 patients per country) were included, with mean age of 56 years (SD13) and 82% women. Mean SJC varied between 6.7 (Morocco) and 0.9 (The Netherlands), mean mHAQ ranged between 0.7 (Taiwan) and 1.5 (The Netherlands). Venezuela had the lowest (1.7) and the Netherlands the highest score on fatigue (5.0). In fully adjusted models, lower GDP was associated with worse physician-reported outcomes (1.85 and 2.84 more swollen and tender joints, respectively, and 1.0 point higher DAS28-3v), but only slightly worse performance-based patient-reported outcome (0.15 higher mHAQ), and with better evaluation-based patient-reported outcomes (0.43 and 0.97 points lower on patient global assessment and fatigue, respectively).

CONCLUSIONS

In patients with RA, important differences in physician-reported and patient-reported outcomes across countries were seen, with overall a paradox of worse physician-reported outcomes but better patient-reported outcomes in low-income countries, while results indicate that these outcomes in multinational studies should be interpreted with caution. Research on explanatory factors of this paradox should include non-disease driven cultural factors influencing health.

摘要

目的

调查不同社会经济发展水平国家类风湿关节炎（RA）患者的患者报告和医生报告的疾病结局模式。

方法

使用一项跨国横断面研究（COMOrbidities in RA）的数据。居住国的社会经济福利（国内生产总值（GDP）；高与低）对医生报告的结局（压痛关节数、肿胀关节数（SJC）、红细胞沉降率、基于 28 个关节评估的疾病活动评分（DAS28）-基于这三个组成部分的 3v 和医生整体评估）和患者报告的结局（改良健康评估问卷（mHAQ）、患者整体评估和疲劳）的贡献，通过线性回归进行了探索，调整了相关混杂因素。

结果

共纳入来自 17 个国家的 3920 例 RA 患者（每个国家 30 至 411 例），平均年龄 56 岁（SD13），82%为女性。SJC 的平均值在 6.7（摩洛哥）和 0.9（荷兰）之间，mHAQ 的平均值在 0.7（中国台湾）和 1.5（荷兰）之间。委内瑞拉的疲劳评分最低（1.7），荷兰的疲劳评分最高（5.0）。在完全调整的模型中，较低的 GDP 与医生报告的结局较差相关（分别多出现 1.85 个和 2.84 个肿胀和压痛关节，DAS28-3v 高 1.0 分），但患者报告的基于表现的结局仅略差（mHAQ 高 0.15 分），且患者报告的基于评估的结局较好（患者整体评估和疲劳低 0.43 和 0.97 分）。