Discordance between patient and physician reported global disease activity in PsA is associated with mental health—a cross-sectional analysis

Psoriatic arthritis (PsA) is a complex disease with heterogeneous disease manifestations. Composite scores including patient reported parameters are the recommended tools to measure these different aspects. Patient and physician often show discordance in their disease assessment. To describe the discordance between patient (PtGA) and physician reported global disease activity (PhGA) and to show its association with mental health. Descriptive cross-sectional analysis of three independent cohorts of PsA patients - RABBIT-SpA register, national database (NDB), RheumaDatenRheport GbR (RHADAR) network - receiving routine rheumatology care in Germany. Association between depressive symptoms and discordance between PtGA and PhGA was analysed using a linear regression model taking age, sex, and depression score into account. 1931 RABBIT-SpA, 1794 NDB, and 1728 RHADAR patients were analysed. Mean age was 55, 56, and 60 years. Mean discordance (PtGA-PhGA) was 1.8 in RABBIT-SPA, 1.9 in NDB, and 2 in RHADAR. Discordance > = 3 was present in 34% (RABBIT-SpA), 35% (NDB), and 37% (RHADAR). Discordance increased with increasing PtGA. In patients with severe depressive symptoms, discordance was larger than in those with no depressive symptoms. Depressive symptoms were significantly associated with discordance also if age and sex were accounted for. In this analysis of three independent PsA cohorts, we found a clinically meaningful discordance between physician and patient assessed disease activity in more than a third of the patients. As patients report higher levels of disease activity, discordant judgments become increasingly prevalent. Depressive symptoms are strongly associated with discordant assessments of global disease activity.