Impact of discordance between patient's and evaluator's global assessment on treatment outcomes in 14 868 patients with spondyloarthritis

Rheumatology (Oxford). 2020 Sep 1;59(9):2455-2461. doi: 10.1093/rheumatology/kez656.


Objectives: To assess the impact of 'patient's minus evaluator's global assessment of disease activity' (ΔPEG) at treatment initiation on retention and remission rates of TNF inhibitors (TNFi) in psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA) patients across Europe.

Methods: Real-life data from PsA and axSpA patients starting their first TNFi from 11 countries in the European Spondyloarthritis Research Collaboration Network were pooled. Retention rates were compared by Kaplan-Meier analyses with log-rank test and by Cox regression, and remission rates by χ2 test and by logistic regression across quartiles of baseline ΔPEG, separately in female and male PsA and axSpA patients.

Results: We included 14 868 spondyloarthritis (5855 PsA, 9013 axSpA) patients. Baseline ΔPEG was negatively associated with 6/12/24-months' TNFi retention rates in female and male PsA and axSpA patients (P <0.001), with 6/12/24-months' BASDAI < 2 (P ≤0.002) and ASDAS < 1.3 (P ≤0.005) in axSpA patients, and with DAS28CRP(4)<2.6 (P ≤0.04) and DAPSA28 ≤ 4 (P ≤0.01), but not DAS28CRP(3)<2.6 (P ≥0.13) in PsA patients, with few exceptions on remission rates. Retention and remission rates were overall lower in female than male patients.

Conclusion: High baseline patient's compared with evaluator's global assessment was associated with lower 6/12/24-months' remission as well as retention rates of first TNFi in both PsA and axSpA patients. These results highlight the importance of discordance between patient's and evaluator's perspective on disease outcomes.

Keywords: TNF inhibitors; axial spondyloarthritis; psoriatic arthritis; treatment outcomes.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Arthritis, Psoriatic / drug therapy*
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Logistic Models
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care / statistics & numerical data*
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Proportional Hazards Models
  • Registries
  • Remission Induction
  • Severity of Illness Index*
  • Spondylarthritis / drug therapy*
  • Treatment Outcome
  • Tumor Necrosis Factor Inhibitors / therapeutic use


  • Tumor Necrosis Factor Inhibitors