fetching data ... 
Background: In daily clinical practice, it is not rare to observe a relevant discordance between patient’s global assessment (PGA) and physician’s global assessment (PhGA), because of different illness perceptions.
Objectives: To evaluate the presence of PGA/PhGA discrepancy in patients with Systemic Lupus Erythematosus (SLE) who achieved clinical remission and to evaluate how this discrepancy affects PROs. In addition, to explore whether this discordance could be influenced by the presence of additional elements affecting patients’ quality of life, such as comorbidities, sleep disturbances and psycho-emotional factors.
Methods: Our study included adult SLE patients consecutively followed in a single Lupus Clinic from March to July 2021 fulfilling at minimum the definition of clinical remission of treatment according to Zen et al. (1) (cSLEDAI=0, corticosteroids ≤5mg/die, stable dosage of DMARD). Medical records including demographic data, clinical characteristics and outcomes measures were collected. Pain assessment, PGA and PhGA were rated on a visual analogue scale (0-100 mm) on the same day of the clinical evaluation. To analyse the discrepancy between PGA and PhGA, the [PGA-PhGA] variable was calculated, considering as discordant a difference ≥ 25 mm as previously proposed (2) All the subjects completed the following questionnaires: Health Assessment Questionnaire (HAQ), SF36 Health Survey, State-Trait Anxiety Inventory (STAI-Y1/Y2), Self-rating Depression Scale (SDS Zung) and Insomnia Severity Index. Statistical analysis was performed to compare concordant and discordant groups.
Results: The study included 106 patients, (93 women, 13 men) with a median age of 48 (41-58) and a median SLE duration 227 months (124-330). At the last evaluation median SLEDAI was 0 (0-2) and median SLICC was 1 (0-1). According to Zen definitions of remission, 51 patients (48%) and 20 (19%) also fulfilled the criteria of clinical remission off corticosteroids and complete remission respectively. Nevertheless, in 24 patients (22,7%) [PGA-PhGA]≥25. Patients in the discordant group were older (median 58 years, IQR 49-62 vs 46, IQR 39-57; p=0,0043) and less frequently achieved the definition of clinical remission off corticosteroids (n=4, 16,7% vs n=47, 57,3%,p<0.001;OR6,7; CI95%2.1-21) than concordant. No differences were found in gender, SLE duration, serology, disease activity or damage and other treatment. Data about differences in PROs between two groups are reported in
Data are expressed as median and interquartile range (IQR) and compared using Mann-Whitney test.
| TOTAL N=106 (%) | CONCORDANT GROUP (PGA-PhGA) <25N=82 (%) | DISCORDANT GROUP (PGA-PhGA) ≥25N=24 (%) | P value | |
|---|---|---|---|---|
| VAS-pain [0-100], | 10 (0-30) | 10 (0-20) | 50 (40-60) | < 0.001 |
| SF-36 Physical Component Summary (PCS) | 50 (37,5-53) | 51 (44-54) | 30 (27,5-39) | < 0.001 |
| SF-36 Mental Component Summary (PCS) | 48 (38-55) | 51 (40-55) | 40 (36-48,5) | 0,015 |
| STAI-Y1 [20-80] | 35 (30-47) | 33 (28,3-45,5) | 42 (36,5-49,5) | 0,013 |
| STAI-Y2 [20-80] | 37 (30-46) | 35 (29-43,3) | 42 (36-46) | 0,021 |
| Test di Zung [20-80] | 34,5 (29-43) | 33 (27-43) | 39 (35,5-44,5) | 0,008 |
| Insomnia severity index [0-28] | 6 (2-12) | 4 (1-9) | 9 (6,8-14,3) | <0,0001 |
| HAQ | 0 (0-0,1) | 0 (0-0) | 0,38 (0-0,6) | < 0.001 |
Conclusion: In our study we found that, even in patients considered in remission, in more than 20% of patients there is a considerable discordance between the global disease assessment reported by patients and their physicians. Patients that had a higher PGA also presented worse score at PROs. Our data seems to confirm that potential causes for discordance could be more related to the presence of non-inflammatory processes, depression, or anxiety than clinical manifestations or damage related to SLE.
REFERENCES:
[1]Zen et al. Ann. Rheum. Dis. 2015;74:2117–2122
[2]Neville C, et al. J Rheumatol 2000;27:675-9
Disclosure of Interests: None declared