LAUSR

Background Psoriatic arthritis (PsA) is a chronic inflammatory articular disease with diverse clinical manifestations. Few biomarkers are available to assess disease activity in PsA. Hence, both the patient’s and the physician’s assessment of disease activity is vital in ensuring optimal treatment outcomes. Understanding factors associated with patient and physician discordance can facilitate shared decision making and treatment management between patient and physician. There is limited data on factors associated with patient and physician discordance in psoriatic arthritis; none of which exist in the Asian population. Objectives To identify the factors associated with patient-physician discordance in a multi-ethnic Asian cohort of Psoriatic arthritis (PsA) patients. Methods Data was obtained from a prospective cohort of consecutive patients with psoriatic arthritis, who fulfil the CASPAR criteria recruited from a single centre in Singapore. Sociodemographic, clinical data and patient reported outcomes were collected using a standardised protocol at baseline, 4 months, 8 months, 1 year and 2 years. Patient-physician discordance was defined as patient global assessment minus physician global assessment (PGA - PhGA). We evaluated factors associated with patient-physician using generalised linear regression to control for within-subject effect. Results From 126 patients (50.4% male, 67.5% Chinese, age: 51±13.8 years, duration of illness: 5.6±6.1 years) recruited at baseline, paired data for patient and physician global assessments were available for 224 visits over a median follow up of 10 (range 0–15) months. In univariable analysis, gender, duration of illness, fatigue, pain score, number of tender joint/swollen joint/dactylitis, mental health subscale of SF36 and physical function by Health Assessment Questionnaire (HAQ) were significantly associated with patient-physician discordance. In multivariable analysis, higher level of fatigue, higher pain score, poorer mental health were associated with PGA-PhGA; while higher swollen joint and dactylitis count were negatively associated with PGA-PhGA (table 1).Abstract THU0295 – Table 1 Multivariable analysis for factors associated with patient-physician discordance Factors β 95% Confidence Interval p-value Age 0.211 (−0.029, 0.452) 0.085 GenderFemaleMale −3.687Ref (−8.830, 1.457)- 0.160- EthnicityChineseNon-Chinese −1.085Ref (−6.654, 4.484)- 0.703- EducationSecondary or belowPost-secondary (>10 years) - 6.105Ref (−12.2,–0.012)- 0.050- Duration of illness (years) 0.252 (−0.187, 0.692) 0.261 Fatiguea 1.964 (0.577–3.350) 0.005 Paina 0.456 (0.312–0.601) <0.001 Tender joint count −1.006 (−2.197, 0.184) 0.098 Swollen joint count −3.312 (−5.095,–1.528) <0.001 Dactylitis count −3.059 (−5.594,–0.523) 0.018 HAQa −2.265 (−8.619, 4.090) 0.485 SF36-mental health domaina 0.958 (0.169–1.747) 0.017 Reference [1] A Higher score represents poorer status Abbreviations HAQ: Physical function by Health Assessment Questionnaire; SF36: Medical Outcome Short Form 36 Conclusions Higher pain score, higher level of fatigue and poorer mental health may explain underestimation of patient global assessment by physicians. Higher swollen joint and dactylitis count may explain overestimation of physician global assessment. Disclosure of Interest None declared