Learning from discordance in patient and physician global assessments of systemic lupus erythematosus disease activity

Objective. Differences have been described between patient and physician as sessments of well being in several chronic illnesses, and these differences may affect outcome. Disagreement may lead to dissatisfaction and to behavi ors with dangerous consequences. We describe and identify predictors of pat ient-physician differences on ratings of disease activity in systemic lupus erythematosus (SLE). Methods. Data collected on 154 patients included age, education, disease du ration, and patient and physician global assessments of lupus activity on a 10 cm visual analog scale (VAS), the Health Assessment Questionnaire (HAQ) , the Medical Outcome Study Short-Form 36 (SF-36), the Systemic Lupus Disea se Activity Index (SLEDAI), the Systemic Lupus Activity Measure (SLAM-R), a nd the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). Multiple linear regression models were performed using patient VAS scores, physician VAS scores, and patient minus physician VAS scores as the dependent variables, and age, disease duration , selected SF-36 and SLAM-R subscales, and SDI as independent variables. Results. Patients were 90% female and 80% Caucasian, with a mean education of 13 +/- 2.8 years and a mean age of 43.1 +/- 13.6 years. The overall mean disease duration was 10.5 +/- 7.8 years. Physicians overscored patients by 2.5 cm in 6% of the cases and patients overscored physicians in 16% of the cases. The best multivariate model to predict overall differences included SF-36 mental health and SLAM-R kidney scores. Conclusion. Patient-physician differences may result from a divergence in f ocus. Patients score lupus activity based on their psychological status, wh ile physicians rely more heavily on the physical effect of the disease.