POS1043 SUBJECTIVE FACTORS INFLUENCING THE PHYSICIAN’S GLOBAL ASSESSMENT OF DISEASE IN PATIENTS WITH RHEUMATOID ARTHRITIS (2024)

Abstract

Background: Patient Global Assessment (PGA) and Physician Global Assessment (PhGA) are pivotal tools in outlining disease activity in rheumatoid arthritis (RA) to define a clinical remission state, the main target of the treatment (1). A fair amount of literature confirmed that patients primarily evaluate their general well-being, which certainly encompasses disease activity but also other factors such as fatigue, psychological stress, and comorbidities (2). Conversely, only a few studies examined whether physicians’ scores might be influenced by factors unrelated to objective findings (i.e. physical examination, imaging and laboratory results, and use of corticosteroids) (3).

Objectives: The present study aims to investigate whether and which physician’s characteristics might influence the PhGA score.

Methods: This observational cross-sectional study enrolled 546 consecutive patients diagnosed with RA receiving biological/targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs). Socio-demographic data, clinical and laboratory parameters, ongoing therapies, drug history, PGA, and PhGA were collected. Moreover, we recorded the age, gender, and level of experience of the physicians (residents, rheumatologists with less than 10 years of experience, rheumatologists with 10 to 20 years of experience, and rheumatologists with more than 20 years of experience) who examined the abovementioned patients. Univariate analyses, correlations, and multiple linear regression analyses were performed.

Results: Patients’ characteristics are shown in Table 1. Twenty-one rheumatologists were involved (14 women and 7 men), with a median age (Q1-Q3) of 49 (33-52); 9 were residents, 4 had less than 10 years of experience, 4 between 10 to 20 years of experience, and 4 had more than 20 years of experience. Univariate analyses showed higher PhGA scores in patients receiving glucocorticoids and nonsteroidal anti-inflammatory drugs (NSAIDs) (p<0,001 and p=0,024, respectively) refractory (p=0,008), and meeting the definition of “difficult to treat” (p<0,001). Significant positive correlations emerged between PhGA scores and glucocorticoids dose (p=0,037), TJC and SJC (both p<0,001), PCR (p<0,001), numbers of previous biological drugs and failed mechanisms of action (p=0,023 and p=0,007, respectively), and physician’s age (p=0,011). Multiple linear regression analyses (Table 2) showed that disease duration, TJC, SJC, physician’s older age, and female sex were associated with higher PhGA scores. A negative association was also found between the presence of osteoarthritis and PhGA.

Conclusion: Albeit Inflammatory markers proved to be the main factors influencing the PhGA, along with disease duration and the presence of osteoarthritis, physician characteristics such as female sex and older age seem to play an equally important role in the assessment of disease activity, thus partially reflected the few data existing in the literature (3).

Acknowledgements: NIL.

Disclosure of Interests: Cristina Posio: None declared, Silvia Cavalli: None declared, Gilberto Cincinelli: None declared, Laura Giudice: None declared, Gabriella Maioli: None declared, Ilaria Suardi: None declared, Francesca Ingegnoli: None declared, Roberto F. Caporali RC has been a consultant for and/or received honoraria as a speaker for AbbVie, Amgen, BMS, Celltrion, Fresenius, Galapagos, Janssen, Eli Lilly, Novartis, Pfizer, and UCB Pharma, RC has been a consultant for and/or received honoraria as a speaker for AbbVie, Amgen, BMS, Celltrion, Fresenius, Galapagos, Janssen, Eli Lilly, Novartis, Pfizer, and UCB Pharma.