Patient and physician global assessments capture distinct clinical domains in axial spondyloarthritis.

BACKGROUND

Patient global (PtGA) and physician global (PhGA) assessments are key components of disease evaluation in axial spondyloarthritis (axSpA). Although commonly used in composite indices, these measures are often interpreted as interchangeable indicators of disease activity. It remains unclear whether PtGA and PhGA reflect overlapping or distinct clinical domains.

METHODS

In this cross-sectional study, 155 patients fulfilling the modified New York criteria, with ASAS classification criteria additionally recorded, were included. All patients had radiographic and MRI-confirmed sacroiliitis. Patient-reported outcomes included PtGA (0-10 VAS), fatigue (0-100), and Beck Depression Inventory (BDI). PhGA (0-10 VAS) was assessed independently by the evaluating physician. Laboratory parameters included erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Spinal mobility was evaluated using the modified Schober test, tragus-to-wall distance, and chest expansion. Associations were examined using Spearman correlation and multivariate linear regression analyses including demographic variables.

RESULTS

PtGA showed strong correlations with depressive symptoms (ρ = 0.61, p < 0.001) and fatigue (ρ = 0.53, p < 0.001), while correlations with inflammatory markers were weak. In multivariate analyses, BDI (β = 0.087, p < 0.001), fatigue (β = 0.015, p = 0.002), ESR (β = 0.040, p = 0.001), disease duration (β =  - 0.068, p = 0.036), and tragus-to-wall distance (β = 0.069, p = 0.040) remained independently associated with PtGA (adjusted R2 = 0.402), whereas spinal mobility measures were not significant. In contrast, PhGA was independently associated with modified Schober (β =  - 0.200, p = 0.031), tragus-to-wall distance (β = 0.061, p = 0.043), ESR (β = 0.031, p = 0.004), and BDI (β = 0.075, p < 0.001) (adjusted R2 = 0.434). CRP and demographic variables were not significant predictors of either global assessment.

CONCLUSION

Patient and physician global assessments capture distinct clinical domains in axSpA. PtGA is predominantly influenced by psychological burden and fatigue, whereas PhGA is more strongly associated with structural impairment and inflammatory burden. These findings highlight the multidimensional nature of disease perception and support domain-targeted clinical evaluation. Key Points • Patient and physician global assessments in axial spondyloarthritis reflect partially overlapping but distinct clinical domains. • Patient global assessment is primarily driven by depressive symptoms and fatigue rather than objective inflammatory or structural parameters. • Physician global assessment is independently associated with spinal mobility impairment and inflammatory burden. • Interpreting PG-MD differences as domain-specific weighting rather than discordance may improve multidimensional disease assessment.