Understanding patient and physician global assessments in rheumatoid arthritis: A meta-epidemiological study of core outcome set performance

Philip Rask Lage-Hansen; Tobias Haugegaard; Bjørk Khaliqi Sofíudóttir; Nikoletta Svendsen; Jamie J Kirkham; Kirstine Amris; Maarten de Wit; Maarten Boers; Maja Skov Kragsnaes; Ernest Choy; Torkell Ellingsen; Robin Christensen

doi:10.1016/j.semarthrit.2026.153023

Understanding patient and physician global assessments in rheumatoid arthritis: A meta-epidemiological study of core outcome set performance

Philip Rask Lage-Hansen^*
, Tobias Haugegaard
, Bjørk Khaliqi Sofíudóttir
, Nikoletta Svendsen
, Jamie J Kirkham
, Kirstine Amris
, Maarten de Wit
, Maarten Boers
, Maja Skov Kragsnaes
, Ernest Choy
, Torkell Ellingsen
, Robin Christensen

^*Corresponding author for this work

Medicine (NSR)

Research output: Contribution to journal › Review › Research › peer-review

Abstract

OBJECTIVE: To assess agreement between physician and patient global assessment improvements in randomised controlled trials (RCT) of targeted therapies for rheumatoid arthritis and to identify which core outcome domains best explain changes in each assessment and their discrepancies.

METHODS: We conducted a systematic review and meta-epidemiological analysis of RCTs comparing targeted therapies with placebo. Standardised mean differences (SMDs) were calculated for all eight RA-COS domains: Physician global assessment, Patient global assessment, Disability, Tender joint count (TJC), Swollen joint count (SJC), Pain, Acute phase reactants, and Fatigue. Agreement between physician and patient assessments was assessed as ΔSMD Global (i.e., SMD Physician global assessment - SMD Patient global assessment). Multivariate meta-analyses were performed to calculate SMD for the remaining domains. Multiple imputation followed by meta-regression analyses identified domain-level predictors of global assessment changes.

RESULTS: We identified 73 double-blind RCTs (165 randomised comparisons) involving 33,956 RA patients. Physician assessments demonstrated slightly greater treatment effects (SMD -0.60; 95% CI -0.65 to -0.55) compared with patient assessments (SMD -0.50; 95% CI -0.54 to -0.46): ΔSMDGlobal = -0.09 (95% CI -0.12 to -0.05). Univariable meta-regression identified disability, TJC and SJC as the strongest associations of both assessments, yet SJC was the only domain significantly associated with the contrast between these (ΔSMDGlobal). Pain was independently associated only with patient global assessment.

CONCLUSION: Targeted therapies show larger improvements in physician-assessed outcomes than on patient-reported outcomes, largely driven by SJC. Pain remains a distinct determinant of patient assessments, underscoring the need to better integrate patient-reported outcomes into RA trial design.

REGISTRATION: The protocol was registered on PROSPERO (2025-02-14).

REGISTRATION NUMBER: CRD420250652342.

Original language	English
Article number	153023
Number of pages	8
Journal	Seminars in Arthritis and Rheumatism
Volume	79
Early online date	14 Jun 2026
DOIs	https://doi.org/10.1016/j.semarthrit.2026.153023
Publication status	Published - Aug 2026

Keywords

Core outcome set
Meta-analysis
Patient perspective
Physician perspective
Disability Evaluation
Severity of Illness Index
Physicians
Humans
Arthritis, Rheumatoid/drug therapy
Treatment Outcome
Randomized Controlled Trials as Topic
Antirheumatic Agents/therapeutic use
Patient Reported Outcome Measures

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10.1016/j.semarthrit.2026.153023

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Lage-Hansen, P. R., Haugegaard, T., Sofíudóttir, B. K., Svendsen, N., Kirkham, J. J., Amris, K., de Wit, M., Boers, M., Kragsnaes, M. S., Choy, E., Ellingsen, T., & Christensen, R. (2026). Understanding patient and physician global assessments in rheumatoid arthritis: A meta-epidemiological study of core outcome set performance. Seminars in Arthritis and Rheumatism, 79, Article 153023. https://doi.org/10.1016/j.semarthrit.2026.153023

@article{db7f88895b084ee991c6684621ed7021,

title = "Understanding patient and physician global assessments in rheumatoid arthritis: A meta-epidemiological study of core outcome set performance",

abstract = "OBJECTIVE: To assess agreement between physician and patient global assessment improvements in randomised controlled trials (RCT) of targeted therapies for rheumatoid arthritis and to identify which core outcome domains best explain changes in each assessment and their discrepancies.METHODS: We conducted a systematic review and meta-epidemiological analysis of RCTs comparing targeted therapies with placebo. Standardised mean differences (SMDs) were calculated for all eight RA-COS domains: Physician global assessment, Patient global assessment, Disability, Tender joint count (TJC), Swollen joint count (SJC), Pain, Acute phase reactants, and Fatigue. Agreement between physician and patient assessments was assessed as ΔSMD Global (i.e., SMD Physician global assessment - SMD Patient global assessment). Multivariate meta-analyses were performed to calculate SMD for the remaining domains. Multiple imputation followed by meta-regression analyses identified domain-level predictors of global assessment changes.RESULTS: We identified 73 double-blind RCTs (165 randomised comparisons) involving 33,956 RA patients. Physician assessments demonstrated slightly greater treatment effects (SMD -0.60; 95\% CI -0.65 to -0.55) compared with patient assessments (SMD -0.50; 95\% CI -0.54 to -0.46): ΔSMDGlobal = -0.09 (95\% CI -0.12 to -0.05). Univariable meta-regression identified disability, TJC and SJC as the strongest associations of both assessments, yet SJC was the only domain significantly associated with the contrast between these (ΔSMDGlobal). Pain was independently associated only with patient global assessment.CONCLUSION: Targeted therapies show larger improvements in physician-assessed outcomes than on patient-reported outcomes, largely driven by SJC. Pain remains a distinct determinant of patient assessments, underscoring the need to better integrate patient-reported outcomes into RA trial design.REGISTRATION: The protocol was registered on PROSPERO (2025-02-14).REGISTRATION NUMBER: CRD420250652342.",

keywords = "Core outcome set, Meta-analysis, Patient perspective, Physician perspective, Disability Evaluation, Severity of Illness Index, Physicians, Humans, Arthritis, Rheumatoid/drug therapy, Treatment Outcome, Randomized Controlled Trials as Topic, Antirheumatic Agents/therapeutic use, Patient Reported Outcome Measures",

author = "Lage-Hansen, \{Philip Rask\} and Tobias Haugegaard and Sof{\'i}ud{\'o}ttir, \{Bj{\o}rk Khaliqi\} and Nikoletta Svendsen and Kirkham, \{Jamie J\} and Kirstine Amris and \{de Wit\}, Maarten and Maarten Boers and Kragsnaes, \{Maja Skov\} and Ernest Choy and Torkell Ellingsen and Robin Christensen",

year = "2026",

month = aug,

doi = "10.1016/j.semarthrit.2026.153023",

language = "English",

volume = "79",

journal = "Seminars in Arthritis and Rheumatism",

issn = "0049-0172",

publisher = "W.B. Saunders",

}

Lage-Hansen, PR, Haugegaard, T, Sofíudóttir, BK, Svendsen, N, Kirkham, JJ, Amris, K, de Wit, M, Boers, M, Kragsnaes, MS, Choy, E, Ellingsen, T & Christensen, R 2026, 'Understanding patient and physician global assessments in rheumatoid arthritis: A meta-epidemiological study of core outcome set performance', Seminars in Arthritis and Rheumatism, vol. 79, 153023. https://doi.org/10.1016/j.semarthrit.2026.153023

Understanding patient and physician global assessments in rheumatoid arthritis: A meta-epidemiological study of core outcome set performance. / Lage-Hansen, Philip Rask; Haugegaard, Tobias; Sofíudóttir, Bjørk Khaliqi et al.
In: Seminars in Arthritis and Rheumatism, Vol. 79, 153023, 08.2026.

Research output: Contribution to journal › Review › Research › peer-review

TY - JOUR

T1 - Understanding patient and physician global assessments in rheumatoid arthritis

T2 - A meta-epidemiological study of core outcome set performance

AU - Lage-Hansen, Philip Rask

AU - Haugegaard, Tobias

AU - Sofíudóttir, Bjørk Khaliqi

AU - Svendsen, Nikoletta

AU - Kirkham, Jamie J

AU - Amris, Kirstine

AU - de Wit, Maarten

AU - Boers, Maarten

AU - Kragsnaes, Maja Skov

AU - Choy, Ernest

AU - Ellingsen, Torkell

AU - Christensen, Robin

PY - 2026/8

Y1 - 2026/8

N2 - OBJECTIVE: To assess agreement between physician and patient global assessment improvements in randomised controlled trials (RCT) of targeted therapies for rheumatoid arthritis and to identify which core outcome domains best explain changes in each assessment and their discrepancies.METHODS: We conducted a systematic review and meta-epidemiological analysis of RCTs comparing targeted therapies with placebo. Standardised mean differences (SMDs) were calculated for all eight RA-COS domains: Physician global assessment, Patient global assessment, Disability, Tender joint count (TJC), Swollen joint count (SJC), Pain, Acute phase reactants, and Fatigue. Agreement between physician and patient assessments was assessed as ΔSMD Global (i.e., SMD Physician global assessment - SMD Patient global assessment). Multivariate meta-analyses were performed to calculate SMD for the remaining domains. Multiple imputation followed by meta-regression analyses identified domain-level predictors of global assessment changes.RESULTS: We identified 73 double-blind RCTs (165 randomised comparisons) involving 33,956 RA patients. Physician assessments demonstrated slightly greater treatment effects (SMD -0.60; 95% CI -0.65 to -0.55) compared with patient assessments (SMD -0.50; 95% CI -0.54 to -0.46): ΔSMDGlobal = -0.09 (95% CI -0.12 to -0.05). Univariable meta-regression identified disability, TJC and SJC as the strongest associations of both assessments, yet SJC was the only domain significantly associated with the contrast between these (ΔSMDGlobal). Pain was independently associated only with patient global assessment.CONCLUSION: Targeted therapies show larger improvements in physician-assessed outcomes than on patient-reported outcomes, largely driven by SJC. Pain remains a distinct determinant of patient assessments, underscoring the need to better integrate patient-reported outcomes into RA trial design.REGISTRATION: The protocol was registered on PROSPERO (2025-02-14).REGISTRATION NUMBER: CRD420250652342.

AB - OBJECTIVE: To assess agreement between physician and patient global assessment improvements in randomised controlled trials (RCT) of targeted therapies for rheumatoid arthritis and to identify which core outcome domains best explain changes in each assessment and their discrepancies.METHODS: We conducted a systematic review and meta-epidemiological analysis of RCTs comparing targeted therapies with placebo. Standardised mean differences (SMDs) were calculated for all eight RA-COS domains: Physician global assessment, Patient global assessment, Disability, Tender joint count (TJC), Swollen joint count (SJC), Pain, Acute phase reactants, and Fatigue. Agreement between physician and patient assessments was assessed as ΔSMD Global (i.e., SMD Physician global assessment - SMD Patient global assessment). Multivariate meta-analyses were performed to calculate SMD for the remaining domains. Multiple imputation followed by meta-regression analyses identified domain-level predictors of global assessment changes.RESULTS: We identified 73 double-blind RCTs (165 randomised comparisons) involving 33,956 RA patients. Physician assessments demonstrated slightly greater treatment effects (SMD -0.60; 95% CI -0.65 to -0.55) compared with patient assessments (SMD -0.50; 95% CI -0.54 to -0.46): ΔSMDGlobal = -0.09 (95% CI -0.12 to -0.05). Univariable meta-regression identified disability, TJC and SJC as the strongest associations of both assessments, yet SJC was the only domain significantly associated with the contrast between these (ΔSMDGlobal). Pain was independently associated only with patient global assessment.CONCLUSION: Targeted therapies show larger improvements in physician-assessed outcomes than on patient-reported outcomes, largely driven by SJC. Pain remains a distinct determinant of patient assessments, underscoring the need to better integrate patient-reported outcomes into RA trial design.REGISTRATION: The protocol was registered on PROSPERO (2025-02-14).REGISTRATION NUMBER: CRD420250652342.

KW - Core outcome set

KW - Meta-analysis

KW - Patient perspective

KW - Physician perspective

KW - Disability Evaluation

KW - Severity of Illness Index

KW - Physicians

KW - Humans

KW - Arthritis, Rheumatoid/drug therapy

KW - Treatment Outcome

KW - Randomized Controlled Trials as Topic

KW - Antirheumatic Agents/therapeutic use

KW - Patient Reported Outcome Measures

U2 - 10.1016/j.semarthrit.2026.153023

DO - 10.1016/j.semarthrit.2026.153023

M3 - Review

C2 - 42330661

SN - 0049-0172

VL - 79

JO - Seminars in Arthritis and Rheumatism

JF - Seminars in Arthritis and Rheumatism

M1 - 153023

ER -

Understanding patient and physician global assessments in rheumatoid arthritis: A meta-epidemiological study of core outcome set performance

Abstract

Keywords

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