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Table 4 Summary of PGA aspects discussed in this review

From: Patient global assessment in measuring disease activity in rheumatoid arthritis: a review of the literature

Aspects covered Main findings
Description and practical application Two different concepts covered: global health versus disease activity
The wording/phrasing and time-reference used remain unstandardized, leading to differences in interpretation and therefore the responses obtained
There exist different scales to score PGA
Psychometric properties Practical, feasible, and non-costly to use in routine clinical practice
High face validity but its broad concept can lead to difficulties with interpretation
Good reliability and sensitive to change, making it useful in clinical practice and in research
Consequences of heterogeneity Differences in interpretation of results
Impact on DAS28 scoring and therefore the achievement of remission
Elements explaining PGA RA disease activity as indirectly reflected by inflammation, pain, and functional incapacity (partly due to joint damage) and fatigue explain a large component of the PGA
Psychological distress can result in higher PGA
Conflicting evidence exists on the impact of comorbidities on PGA
Non-RA factors impacting on PGA include demographic characteristics, education, culture, and geographic origin
Differences in patient understanding and interpretation affect the responses
Discordance between PGA and physician global assessment More objective measures of disease, e.g., joint counts and acute phase reactants lead to a higher physician global assessment whereas pain and altered quality of life without visible signs of inflammation result in higher PGA
Patient–physician discordance can affect DAS28 scoring and decision-making, e.g., treatment escalation