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Rheumatology Advance Access published online on June 16, 2006
Rheumatology, doi:10.1093/rheumatology/kel201
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© The Author 2006. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Received February 3, 2006
Accepted May 9, 2006

Original Papers

Discordance between physician's and parent's global assessments in juvenile idiopathic arthritis

F. Sztajnbok 1, D. L. Coronel-Martinez 1, A. Diaz-Maldonado 1, C. Novarini 1, A. Pistorio 2, S. Viola 1, N. Ruperto 1, A. Buoncompagni 1, A. Martini 3, and A. Ravelli 1 *

1 Pediatria II, Istituto di Ricovero e Cura a Carattere Scientifico G. Gaslini, Genova, Italy
2 Servizio di Epidemiologia e Biostatistica, Istituto di Ricovero e Cura a Carattere Scientifico G. Gaslini, Genova, Italy
3 Pediatria II, Istituto di Ricovero e Cura a Carattere Scientifico G. Gaslini, Genova, Italy; Dipartimento di Pediatria, Università di Genova, Genova, Italy

* To whom correspondence should be addressed.
A. Ravelli, E-mail: angeloravelli{at}ospedale-gaslini.ge.it


  Abstract

Objective. To investigate the discrepancy between physician's and parent's global assessments of disease status and the factors explaining discordance in patients with juvenile idiopathic arthritis (JIA).

Methods. The mothers of 197 patients with JIA rated the child's overall well-being on a 10 cm visual analogue scale (VAS) and the attending physician rated the child's overall disease activity on a 10 cm VAS. A discordance score was calculated by subtracting the physician's global assessment from that of the parent's, leading to the definition of three patient groups: (1) no discordance, when physician's and parent's assessments were within 1 cm of each other; (2) negative discordance, when parent's assessment was underrated relative to the physician; and (3) positive discordance, when parent's assessment was over-rated relative to the physician. Negative and positive discordance was defined as ‘marked’ when the difference between the two assessments was greater than 3 cm.

Results. No discordance was found in 40.6% of the patients. Negative discordance was found in 51.3% of the patients, with 34% showing marked discordance. Positive discordance was found in 8.1% of the patients, with 2% showing marked discordance. Significant differences between groups included a shorter disease duration among patients with a markedly positive discordance (P = 0.02) and a greater frequency of ongoing second-line drug therapy among patients with no discordance or with positive discordance (P = 0.008). Patients with no discordance or with marked positive discordance had a significantly lower joint counts (P = 0.02-0.004).

Conclusion. Parents and physicians often perceive the health status of children with JIA differently, with parents providing most frequently lower rating.

Keywords: Juvenile idiopathic arthritis; Physician's global assessment; Parent's global assessment; Discordance; Parent-physician agreement.
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