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Understanding patient and physician global assessments in rheumatoid arthritis: A meta-epidemiological study of core

Philip Rask Lage-Hansen¹, Tobias Haugegaard², Bjørk Khaliqi Sofíudóttir³

¹Department of Rheumatology, Esbjerg Hospital, Denmark; Department of Rheumatology, Slagelse Hospital, Denmark; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark; Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.

Seminars in Arthritis and Rheumatism

|June 22, 2026

Abstract

Objective:

To assess agreement between physician and patient global assessment improvements in randomised controlled trials (RCT) of targeted therapies for rheumatoid arthritis and to identify which core outcome domains best explain changes in each assessment and their discrepancies.

Methods:

We conducted a systematic review and meta-epidemiological analysis of RCTs comparing targeted therapies with placebo. Standardised mean differences (SMDs) were calculated for all eight RA-COS domains: Physician global assessment, Patient global assessment, Disability, Tender joint count (TJC), Swollen joint count (SJC), Pain, Acute phase reactants, and Fatigue. Agreement between physician and patient assessments was assessed as ΔSMD _Global (i.e., SMD _{Physician global assessment} - SMD _{Patient global assessment}). Multivariate meta-analyses were performed to calculate SMD for the remaining domains. Multiple imputation followed by meta-regression analyses identified domain-level predictors of global assessment changes.

Results:

We identified 73 double-blind RCTs (165 randomised comparisons) involving 33,956 RA patients. Physician assessments demonstrated slightly greater treatment effects (SMD -0.60; 95% CI -0.65 to -0.55) compared with patient assessments (SMD -0.50; 95% CI -0.54 to -0.46): ΔSMD_Global = -0.09 (95% CI -0.12 to -0.05). Univariable meta-regression identified disability, TJC and SJC as the strongest associations of both assessments, yet SJC was the only domain significantly associated with the contrast between these (ΔSMD_Global). Pain was independently associated only with patient global assessment.

Conclusion:

Targeted therapies show larger improvements in physician-assessed outcomes than on patient-reported outcomes, largely driven by SJC. Pain remains a distinct determinant of patient assessments, underscoring the need to better integrate patient-reported outcomes into RA trial design.

Registration:

The protocol was registered on PROSPERO (2025-02-14).

Registration Number:

CRD420250652342.

Keywords:

Core outcome set Meta-analysis Patient perspective Physician perspective

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