Table 4 Summary of PGA aspects discussed in this review
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 |