Tago Mayu, Sawada Tetsuji, Nishiyama Susumu, Tahara Koichiro, Kato Eri, Hayashi Haeru, Mori Hiroaki, Nishino Jinju, Matsui Toshihiro, Tohma Shigeto
Department of Rheumatology, Tokyo Medical University Hospital, Tokyo, Japan.
Rheumatic Disease Center, Kurashiki Medical Center, Okayama, Japan.
Int J Rheum Dis. 2018 Jun;21(6):1237-1245. doi: 10.1111/1756-185X.13281. Epub 2018 Apr 3.
The discordance between patient global assessment (PGA) and physician global assessment (PhGA) of rheumatoid arthritis (RA) disease activity may be problematic in clinical practice. The aim of this study was to identify determinants of this discordance using a nationwide RA database in Japan (NinJa) with special attention to large joint involvement.
We investigated 12 043 adults with RA and used a discordance cutoff of 3 cm. Large joint involvement was investigated using novel joint indices (x, y, z), where x and y were the indices for upper and lower joints, respectively, and z was for large joint predominance. Predictors of PGA-PhGA discordance and determinants of PGA and PhGA were analyzed by multivariate logistic and linear regression models, respectively.
Multivariate logistic regression identified age, pain and high modified Health Assessment Questionnaire score as predictors of positive discordance (PGA ≥ PhGA), whereas parameters of disease activity in RA (C-reactive protein, x and y), class 3-4 functional status, and z were found to predict against positive discordance. Linear regression analysis revealed that PGA was mainly determined by pain, whereas PhGA was determined by various other factors.
RA care providers should focus on pain and functional disability to decrease PGA-PhGA discordance. High disease activity and large joint involvement decreased PGA-PhGA discordance, indicating that the number and distribution of affected joints influenced the perception of disease activity by patients with RA and their physicians.
在临床实践中，类风湿关节炎（RA）疾病活动度的患者整体评估（PGA）与医生整体评估（PhGA）之间的不一致可能存在问题。本研究的目的是利用日本全国性的RA数据库（NinJa）确定这种不一致的决定因素，并特别关注大关节受累情况。
我们调查了12043例成年RA患者，并使用3 cm的不一致临界值。使用新的关节指数（x、y、z）来研究大关节受累情况，其中x和y分别是上肢和下肢关节的指数，z是大关节优势指数。分别通过多变量逻辑回归和线性回归模型分析PGA-PhGA不一致的预测因素以及PGA和PhGA的决定因素。
多变量逻辑回归确定年龄、疼痛和高改良健康评估问卷评分是正向不一致（PGA≥PhGA）的预测因素，而RA疾病活动度参数（C反应蛋白、x和y）、3-4级功能状态和z被发现可预测正向不一致。线性回归分析显示，PGA主要由疼痛决定，而PhGA由各种其他因素决定。
RA护理人员应关注疼痛和功能残疾，以减少PGA-PhGA不一致。高疾病活动度和大关节受累可减少PGA-PhGA不一致，表明受累关节的数量和分布影响了RA患者及其医生对疾病活动度的认知。
