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Table 5 Discordance between PGA and estimator global assessment and associated factors

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

Study group Study description Patient number (n) Discordance between PGA and EGA Factors associated with discordance
Desthieux et al. 2016 [55] Systematic literature review and meta-analysis 11,879 (12 studies) Frequency of discordance >2.7 cm (weighted mean cutoff): 44.9 %
PGA > EGA: 79.1 %
PGA < EGA: 20.9 %
Drivers of global assessment:
PGA: pain (the most frequent driver of PGA, significant in eight studies [100 % of studies analyzing this driver of PGA]), functional incapacity, fatigue
EGA: swollen and tender joint counts, acute phase reactants
Drivers of discordance:
Depressive symptoms, health literacy
Davis et al. 2014 [56] Consecutive RA patients 127 Frequency of discordance:
PGA > EGA: 16.5 %
PGA < EGA: 10.2 %
PGA > EGA: pain, fatigue, HAQ disability, poor health related quality of life on the SF-36
PGA < EGA: higher numbers of swollen joints, positive rheumatoid factor and lower pain; better overall physical and mental health
Khan et al. 2012 [13] Patients from the multi-national Quantitative Standard Monitoring of Patients with RA (QUEST-RA) database 7028 Mean PGA 4.0 ± 2.7 cm; EGA 2.9 ± 2.4 cm
Frequency of discordance >2 cm:
PGA > EGA: 30 %
PGA < EGA: 6.6 %
PGA > EGA: higher age; higher scores of pain, fatigue, HAQ, and morning stiffness
PGA < EGA: higher SJC, TJC, ESR; lower fatigue score
Barton et al. 2010 [48] Multi-site observational cohort with RA adults consecutively enrolled from two outpatient clinics in the US 223 Mean PGA 4.3 ± 2.6 cm; EGA 3.1 ± 2.1 cm
Frequency of discordance >2.5 cm:
PGA > EGA: 31 %
PGA < EGA: 5 %
PGA > EGA: higher HAQ score; lower SJC; greater depressive symptoms
Nicolau G et al. 2004 [43] Single center cohort of RA patients in Brazil 80 Frequency of discordance ≥1 cm:
PGA > EGA: 44 %
PGA < EGA: 28 %
Frequency of discordance ≥3 cm
PGA > EGA: 24 %
PGA < EGA: 9 %
PGA > EGA: higher pain and HAQ scores and tendency for higher number of comorbid conditions
Studenic et al. [42] Single center observational cohort of RA patients initiating MTX in Austria 646 Mean PGA 3.9 ± 2.7 cm; EGA 2.3 ± 2.1 cm
Frequency of discordance ≥0.5 cm:
PGA > EGA: 61 %
PGA < EGA: 15 %
PGA > EGA: higher pain and lower SJC
  1. EGA estimator global assessment, ESR erythrocyte sedimentation rate, HAQ-DI Health Assessment Questionnaire-Damage Index, MID minimally important difference, PGA patient global assessment, SDD smallest detectable difference, TJC tender joint count, SF-36 36-item Short Form Health Survey