What factors affect discordance between physicians and patients in the global assessment of disease activity in rheumatoid arthritis?

Objective: To identify the level of agreement between patients with rheumatoid arthritis (RA) and physicians in the global assessment of disease activity and to explore factors influencing their discordance. Methods: A total of 4368 patients with RA were analyzed from the KORean Observational study Network for Arthritis (KORONA) database. Patients were divided into four subgroups according to difference from their physicians in the assessment of disease activity by substracting physician's visual analog scale (VAS) from patient's VAS as follows: positive discordance group I (10mm <= discordance <25mm), positive discordance group II (>= 25mm), concordance (<vertical bar 10 vertical bar mm), and negative discordance (<= -10mm). Multinomial logistic regression analysis was performed to identify factors associated with discordance. Results: Only 1350 (29.2%) patients were classified in the concordance group. Positive discordance was found in 52.3% of the patients (n=2425), with 33.7% (n=1563) showing marked discordance (>= 25mm). The high disease activity (OR =1.41), gastrointestinal (GI) disease (OR =1.28), pain (OR =1.12), fatigue (OR =1.07) were consistently associated with positive discordance. Conclusion: More than half of patients with RA thought their disease more severe than their physicians. In addition to high disease activity, pain, fatigue, and sleep disturbance or GI disease were associated with the discordance between physicians and patients with RA.