Discordance in Patient and Physician Global Assessment in Relapsing Polychondritis.

Abstract

OBJECTIVES\nRelapsing polychondritis (RP) is a rare, heterogeneous, systemic inflammatory disease that targets cartilage. Patient-reported outcome measures may differ from physician assessment. This study compared patient global assessment (PtGA) and physician global assessment (PhGA) scores in a prospective cohort of patients with RP.\n\n\nMETHODS\nAdult patients with RP underwent a standardized comprehensive evaluation at ∼6-month intervals. At each visit, three physicians scored PhGA by consensus, and the patient independently completed four patient-reported outcomes: PtGA, SF-36 Health Survey, Brief Illness Perception Questionnaire (BIPQ), and Multidimensional Fatigue Inventory (MFI). Patient-physician discordance was defined as a difference between PtGA and PhGA of\u2009≥\u20093 on a 0-10 scale.\n\n\nRESULTS\n76 patients were evaluated over 154 visits. Median PhGA was 3 (interquartile range 2-3), and median PtGA was 5 (interquartile range 4-7). PtGA and PhGA were concordant in 66 visits (42.9%), and patients scored disease severity ≥3 points higher than physicians scored disease activity (positive discordance) in 84 visits (54.5%). Compared with visits with concordance, visits with positive discordance were associated with significantly worse scores on the MFI, BIPQ, SF-36 Physical component score (PCS), and SF-36 Mental component score (MCS).\n\n\nCONCLUSION\nPatients with RP typically self-report high PtGA which does not align with PhGA. Discordance is likely driven by the high physical and psychological burden of illness experienced by patients. Multifaceted treatment approaches that address the burden of disease in RP from the patient-perspective are needed.