Study of Factors Affecting the Patient Global Visual Analouge Scale in patients of Rheumatoid Arthritis: A Cross Sectional Study

Abstract

BACKGROUND: Rheumatoid arthritis is a chronic inflammatory arthritis marked by symmetrical peripheral polyarthritis. It results in damage to the joints involved and physical disability . Patient reported outcomes(PRO) provide the patients perspective of their condition and their overall health status. The patient global assessment(PGA) is the commonly used PRO in RA The patients are asked to rate their global assessment of disease activity on a visual analogue scale of 0 -100 by answering the question “ Considering all of the ways your arthritis has affected you , how active do you feel your arthritis is ?” Hence “The PGA not only assesses the disease from patient perspective , but also includes various factors affecting the patients in addition to RA” Physician global assessment obtains the perspective of the treating physician or the rheumatologist. The provider, based on his/her expertise evaluates the disease in a numerical scale, and grades the changes or the assessed RA status at that point. It is important to know the factors causing discrepancy between patient and physicians global assessment of disease activity. AIMS AND OBJECTIVES : The aim of this study is to identify the underlying latent factors affecting the patient global assessment and to determine the factors responsible for a discordant score in patients and physicians assessment of disease activity. X METHODS : This study was a hospital based cross sectional study conducted from January 2018 to December 2018. The patients attending the OPD of Rheumatology and/or Medicine , fulfilling the inclusion criteria were included in the study. Their demographic data was collected. History and physical examination was done. They were given 4 questionnaire one each for Fibromyalgia, Modified Health assessment questionnaire, Hamilton’s anxiety Rating scale and Hamilton’s depression scale. The patients were asked to rate their Global disease activity on a Global VAS scale of 0-100 . The Physicians Global assessment score was given for every patient. The patients were grouped into two groups, those with a Patient Global VAS score < 50 and those with Patient Global VAS score >/= 50. The various latent factors that determined the Patients global VAS score was assessed. The patients were also grouped into two to include those with patient-physician concordant score ( i.e, a difference between physician and patient global assessment less than 25 ) and those with patient-physician discordant score ( i.e, a difference between physician and patient global assessment more than or equal to 25) .The factors that were responsible for discordance between the patients Global VAS score And the Physicians Global VAS score were identified. The data was evaluated by calculation of Chi- square and significance was determined by P value. RESULTS: In this study a total of 130 patients were included. The mean age of our study population was 45.59 years . 79.23% were females with a Female to Male ratio of 3.81:1 . The mean duration of the disease was 5.9 years. 66.92% were seropositive RA. 54.62% patients gave Patient Global VAS score of >/= 50. 66.15% patients had a discordance between patient and physician global assessment scores. Factor analysis identified the following factors that affected the patient Global VAS score which included pain, history of frequent analgesic use ,h/o sleep XI disturbance ,absence of DMARD use, presence of extra articular manifestations, involvement of knee joint hampering mobility, a tender joint count more than 5,a swollen joint count more than 5, presence of symptoms suggestive of depression and anxiety , absence of a gainful employment , a family history of arthritis , Modified health assessment score > 3 ,Presence of fibromyalgia. It also yielded factors that were associated with a discordance between patients and physicians Global VAS Score, these included pain, advanced age of the patient, knee joint involvement, presence of symptoms of anxiety, a family h/o arthritis, absence of gainful employment, sleep disturbance, overall health (Based on the MHA Q score), fibromyalgia. CONCLUSION: The various latent factors which can affect the way the patient perceive there disease severity include : pain, frequent analgesic usage, disturbed sleep ,lack of DMARD use ,presence of extra articular manifestations , involvement of knee joints hampering mobility , a tender joint count more than 5 ,a swollen joint count more than 5, presence of symptoms of anxiety or depression , lack of gainful employment , a family history of arthritis, a higher score on Health assessment score(>3) and fibromyalgia. Factors that were associated with a discordance between patients and physicians Global VAS Score ,included pain, advanced age of the patient ,knee joint involvement hampering mobility ,presence of symptoms of anxiety , a family h/o arthritis ,absence of gainful employment ,sleep disturbance ,overall health(Based on the MHA Q score) ,fibromyalgia .