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

Imane Elbinoune; Bouchra Amine; Samira Rostom; Siham Shyen; Dalal Elbadri; Majda Ezzahri; Nada Mawani; Fanata Moussa; Sanae Gueddari; Wabi Moudjibou; Mariam Erraoui; Jihane Bahha; Redouane Abouqal; Bouchra Chkirate; Najia Hajjaj-Hassouni.

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

A cross-sectional study was conducted on 47 children with JIA. The diagnosis of JIA was made according to the criteria of the International League of Association of Rheumatology (ILAR). Parent’s evaluation was based on an overall assessment of the disease by the mother. 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 was the same; (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.

Forty-seven patients were included (28 male, 19 female); mean age was11.59 ± 3.35 years. The mean disease duration of JIA was 4 [2-6] years, with a predominance of oligoarticular 12 cases (25.5%). Concerning the mothers, 43 (91.5%) were housewives, with a mean age of 38.5 ± 8.5 years. No discordance was found in 23 (48.9%) patients. Negative discordance was found in 4 patients (8.5%). Positive discordance was found in 20 patients (42.6%). The positive discrepancy was statistically significant in patients who have increased articular index (p = 0.033), and patient VAS pain (0.008).

Parents and physicians often perceive the health status of children with JIA differently, with the most negative perception among parents, suggesting that parent's evaluation should be taken into account when defining the clinical activity of the disease.

Key words: Juvenile idiopathic arthritis;discordance;Physician’s global assessment;Parent’s global assessment

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