{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T14:58:12Z","timestamp":1740149892916,"version":"3.37.3"},"reference-count":30,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2018,4,3]],"date-time":"2018-04-03T00:00:00Z","timestamp":1522713600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100009619","name":"Japan Agency for Medical Research and Development","doi-asserted-by":"publisher","award":["16ek0410014h0003"],"award-info":[{"award-number":["16ek0410014h0003"]}],"id":[{"id":"10.13039\/100009619","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J of Rheum Dis"],"published-print":{"date-parts":[[2018,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>The discordance between patient global assessment (<jats:styled-content style=\"fixed-case\">PGA<\/jats:styled-content>) and physician global assessment (Ph<jats:styled-content style=\"fixed-case\">GA<\/jats:styled-content>) of rheumatoid arthritis (<jats:styled-content style=\"fixed-case\">RA<\/jats:styled-content>) disease activity may be problematic in clinical practice. The aim of this study was to identify determinants of this discordance using a nationwide <jats:styled-content style=\"fixed-case\">RA<\/jats:styled-content> database in Japan (<jats:italic>NinJa<\/jats:italic>) with special attention to large joint involvement.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We investigated 12 043 adults with <jats:styled-content style=\"fixed-case\">RA<\/jats:styled-content> and used a discordance cutoff of 3 cm. Large joint involvement was investigated using novel joint indices (<jats:italic>x<\/jats:italic>,<jats:italic> y<\/jats:italic>,<jats:italic> z<\/jats:italic>), where <jats:italic>x<\/jats:italic> and <jats:italic>y<\/jats:italic> were the indices for upper and lower joints, respectively, and <jats:italic>z<\/jats:italic> was for large joint predominance. Predictors of <jats:styled-content style=\"fixed-case\">PGA<\/jats:styled-content>\u2010Ph<jats:styled-content style=\"fixed-case\">GA<\/jats:styled-content> discordance and determinants of <jats:styled-content style=\"fixed-case\">PGA<\/jats:styled-content> and Ph<jats:styled-content style=\"fixed-case\">GA<\/jats:styled-content> were analyzed by multivariate logistic and linear regression models, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Multivariate logistic regression identified age, pain and high modified Health Assessment Questionnaire score as predictors of positive discordance (<jats:styled-content style=\"fixed-case\">PGA<\/jats:styled-content> \u2265 Ph<jats:styled-content style=\"fixed-case\">GA<\/jats:styled-content>), whereas parameters of disease activity in <jats:styled-content style=\"fixed-case\">RA<\/jats:styled-content> (C\u2010reactive protein, <jats:italic>x<\/jats:italic> and <jats:italic>y<\/jats:italic>), class 3\u20134 functional status, and <jats:italic>z<\/jats:italic> were found to predict against positive discordance. Linear regression analysis revealed that <jats:styled-content style=\"fixed-case\">PGA<\/jats:styled-content> was mainly determined by pain, whereas Ph<jats:styled-content style=\"fixed-case\">GA<\/jats:styled-content> was determined by various other factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">RA<\/jats:styled-content> care providers should focus on pain and functional disability to decrease <jats:styled-content style=\"fixed-case\">PGA<\/jats:styled-content>\u2010Ph<jats:styled-content style=\"fixed-case\">GA<\/jats:styled-content> discordance. High disease activity and large joint involvement decreased <jats:styled-content style=\"fixed-case\">PGA<\/jats:styled-content>\u2010Ph<jats:styled-content style=\"fixed-case\">GA<\/jats:styled-content> discordance, indicating that the number and distribution of affected joints influenced the perception of disease activity by patients with <jats:styled-content style=\"fixed-case\">RA<\/jats:styled-content> and their physicians.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1756-185x.13281","type":"journal-article","created":{"date-parts":[[2018,4,3]],"date-time":"2018-04-03T09:47:43Z","timestamp":1522748863000},"page":"1237-1245","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Influence of large joint involvement on patient\u2013physician discordance in global assessment of rheumatoid arthritis disease activity analyzed by a novel joint 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