{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T19:16:23Z","timestamp":1773342983052,"version":"3.50.1"},"reference-count":18,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T00:00:00Z","timestamp":1773273600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Despite the widespread implementation of treat-to-target strategies and modern disease-modifying antirheumatic drugs, a substantial proportion of patients with rheumatoid arthritis (RA) continue to report unmet needs (UNs), defined as a mismatch between patient expectations and symptom burden on the one hand and outcomes achieved with current care on the other. Patient\u2013physician discordance in global assessments may reflect multidimensional influences, including pain mechanisms, psychosocial factors, functional impairment, and communication gaps, extending beyond inflammatory disease activity. Methods: In this cross-sectional study, 133 patients with RA and 57 healthy controls were included. UNs were operationalized as the signed difference between patient global assessment and physician global assessment (\u0394PGA\u2013PhGA). Clinical variables, patient-reported outcomes, and Short Form-36 (SF-36) domains were incorporated into two regularized partial correlation network models estimated using the extended Bayesian information criterion graphical least absolute shrinkage and selection operator (EBICglasso). Node centrality indices (strength, signed strength, betweenness, and closeness) were calculated. Network stability was evaluated using 2000 bootstrap resamples and correlation stability (CS) coefficients. Results: In the clinical network, pain intensity demonstrated the highest strength centrality and the strongest direct association with UNs. In contrast, Disease Activity Score in 28 joints with C-reactive protein (DAS28-CRP) showed no direct association with UNs after accounting for shared variance. In the SF-36-based quality-of-life network, UNs exhibited inverse associations, particularly with perceived health change and role\u2013emotional functioning. Stability analyses indicated acceptable to good robustness (clinical network: CS = 0.59 for edge weights and 0.44 for strength; SF-36 network: CS = 0.59), supporting the reliability of the estimated network structures. Conclusions: UNs in RA are not solely determined by inflammatory disease activity but are embedded within interconnected clinical and psychosocial domains. Pain occupies a structurally central position in the clinical network, whereas perceived health change and emotional role limitations characterize the quality-of-life context of UNs. These findings underscore the importance of multidimensional and patient-centered assessment strategies in RA management.<\/jats:p>","DOI":"10.3390\/jcm15062152","type":"journal-article","created":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T09:23:03Z","timestamp":1773307383000},"page":"2152","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Patient\u2013Physician Discordance and Unmet Needs in Rheumatoid Arthritis: A Network Analysis of Clinical and Quality-of-Life Domains"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5053-6896","authenticated-orcid":false,"given":"Sel\u00e7uk","family":"Akan","sequence":"first","affiliation":[{"name":"Internal Medicine Department, Physical Medicine and Rehabilitation Hospital, Ankara City Hospital, Ankara 06800, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mustafa","family":"U\u011furlu","sequence":"additional","affiliation":[{"name":"Psychiatry Department, Ankara City Hospital, Y\u0131ld\u0131r\u0131m Beyaz\u0131t University, Ankara 06800, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Y\u00fcksel","family":"Mara\u015f","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Ankara Bilkent City Hospital, Health Sciences University, Ankara 06800, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevser","family":"Orhan","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation and Rheumatology, Ankara City Hospital, Y\u0131ld\u0131r\u0131m Beyaz\u0131t University, Ankara 06800, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samet","family":"\u00c7evik","sequence":"additional","affiliation":[{"name":"Family Medicine Department, Ankara Bilkent City Hospital, Ankara 06800, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G\u00f6rkem","family":"Karaka\u015f U\u011furlu","sequence":"additional","affiliation":[{"name":"Psychiatry Department, Ankara City Hospital, Y\u0131ld\u0131r\u0131m Beyaz\u0131t University, Ankara 06800, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ebru","family":"Atalar","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Ankara Bilkent City Hospital, Ankara 06800, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1136\/ard.2009.123919","article-title":"Treating rheumatoid arthritis to target: Recommendations of an international task force","volume":"69","author":"Smolen","year":"2010","journal-title":"Ann. 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