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Prevalence and Factors Associated With Patient-Clinician Discordance Among Patients With Rheumatoid Arthritis

Jeffrey R Curtis¹, Robert R McLean², I-Heng Lee³

¹University of Alabama at Birmingham.

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|March 2, 2024

Summary

Patient and clinician assessments of rheumatoid arthritis (RA) disease activity often differ, especially when starting new biologic or Janus kinase inhibitor (JAKi) therapies. Identifying factors associated with this discordance can improve patient-centered care.

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Area of Science:

Rheumatology
Clinical Trial Analysis
Patient-Reported Outcomes

Background:

Patient-clinician discordance in disease assessment is a recognized challenge in managing rheumatoid arthritis (RA).
Understanding factors influencing this discordance is crucial for optimizing treatment strategies, particularly at the initiation of advanced therapies like biologics or Janus kinase inhibitors (JAKi).

Purpose of the Study:

To describe the prevalence of patient-clinician discordance in disease assessment among rheumatoid arthritis (RA) patients initiating their first biologic or JAKi.
To identify factors associated with this discordance at therapy initiation and over 12 months of follow-up in a real-world US registry.

Main Methods:

Analysis of data from the CorEvitas RA Registry, including patients initiating their first biologic or JAKi from February 1, 2015, onwards.
Definition of positive discordance as a ≥30-point difference between patient and physician global assessments (VAS-100).
Use of mixed-effects logistic regression to identify risk factors for positive and persistent discordance at initiation and follow-up visits.

Main Results:

Approximately 30% of patients exhibited positive discordance at any visit, with 10% showing persistent discordance across three visits.
Factors associated with discordance at initiation included worse Clinical Disease Activity Index scores, increased patient-reported pain, fatigue, and functional impairment.
Persistent discordance was linked to disability status, female sex (higher odds), and Medicare insurance (lower odds).

Conclusions:

Patient-clinician discordance in disease assessment is common in rheumatoid arthritis (RA) patients starting biologic or JAKi therapy.
Identified risk factors highlight the need for patient-centric discussions to align treatment decisions with patient experiences and improve therapeutic outcomes.