Clinical and Psychological Factors Associated With Discordance Between Patient and Physician Global Assessments in Psoriatic Arthritis.

OBJECTIVE

This study aimed to investigate the impact of clinical and psychological factors on the discordance between patient and physician global assessments (PGA and PhGA) in patients with psoriatic arthritis (PsA).

METHODS

This cross-sectional study included 160 patients with PsA who met the CASPAR criteria. Discordance was defined as a difference of ≥2 mm or ≥3 mm on a 10-mm visual analog scale (VAS); both thresholds were used in the analyses. Predictors of discordance were identified using logistic regression, and the mediation of pain was tested through structural equation modeling.

RESULTS

The majority of the study population consisted of women (72.5%), with a mean age of 47.8 years (SD, 11.9). Discordance was observed in 54.4% (≥2 mm) and 33.8% (≥3 mm) of patients. Discordance was more common among female patients and patients not in employment and was associated with higher pain, tender joint count, fatigue, morning stiffness, fibromyalgia, anxiety, and functional disability. For the ≥3 mm threshold, female sex (OR: 3.38), lower education (OR: 3.27), and pain VAS ≥4 mm (OR: 8.90) were independent factors. For the ≥2 mm threshold, pain VAS ≥4 mm, and HAQ-DI remained independently associated with discordance. Pain explained nearly half the variance in PGA and PhGA scores and fully mediated the effects of anxiety and fibromyalgia on discordance.

CONCLUSION

Discordance in PsA is influenced by clinical and psychological factors, particularly female sex, lower education, pain, and disability. Pain mediates the effects of anxiety and fibromyalgia, underscoring the value of patient-centered care.