ORIGINAL ARTICLE A cross-sectional study on factors associated with patient–physician discordance in global assessment of patients with axial spondyloarthritis: an Asian perspective Charmaine Tze May WANG, 1,† Warren FONG, 1,3,4,† Yu Heng KWAN, 2 Jie Kie PHANG, 1 Nai Lee LUI, 1 Ying Ying LEUNG, 1 Julian THUMBOO 1,3,4 and Peter P. CHEUNG 4,5 1 Department of Rheumatology and Immunology, Singapore General Hospital, 2 Program in Health Services and Systems Research, Duke-NUS Medical School, 3 Duke-NUS Medical School, 4 Department of Medicine, Yong Loo Lin School of Medicine, National University Singapore, and 5 Division of Rheumatology, National University Hospital, Singapore City, Singapore Abstract Aim: To identify the factors associated with patient–physician discordance in patients with axial spondyloarthri- tis (axSpA) in an Asian population. Methods: A cross-sectional study was conducted in two tertiary referral centers in Singapore. Patients with axSpA who fulfilled Assessment in Ankylosing Spondylitis International Working Group 2009 criteria for axSpA were included in the study. Socio-demographics, clinical, laboratory and patient-reported outcomes data were col- lected during study visits from 2014 to 2015. We performed univariate and multivariate linear regression analy- ses to evaluate the factors associated with patient–physician discordance, which we defined as the difference between Patient Global Assessment and Physician Global Assessment. Results: Included in the study were 298 axSpA patients: 82% male, 81% Chinese, median age 40 (20–78) years, median disease duration 9 (0.1–48) years. 80% were on non-steroidal anti-inflammatory drugs and 23% on bio- logics. In univariate analysis, current age (b: 0.18, q = 0.06), duration of disease (b: 0.34, q = 0.03), post-sec- ondary education level (b: À10.82, q = 0.03), global pain score (b: 0.33, q < 0.01), Bath Ankylosing Spondylitis Functional Index (b: 2.80, q < 0.01), Ankylosing Spondylitis Disease Activity Score C-reactive pro- tein (b: 4.63, q < 0.01) and current use of biologics (b: 10.97, q < 0.01) were associated with patient–physician discordance. In multivariate analysis, global pain score (b: 0.32, q < 0.01), post-secondary education level (b: À12.80, q = 0.01) and current biologics use (b: 16.21, q < 0.01) were associated with patient–physician discor- dance. Conclusion: Higher global pain score, lower educational level and current biologics use were associated with greater patient–physician discordance. These factors should be considered during shared decision making. Key words: discordance, patient reported outcomes, spondyloarthritis. INTRODUCTION Axial spondyloarthritis (axSpA) is a chronic inflamma- tory rheumatic disease characterized by sacroiliitis and spinal inflammation, which may progress to ankylosis over time. 1 Other manifestations of axSpA include peripheral arthritis, enthesitis, dactylitis, as well as extra-articular such as anterior uveitis, psoriasis and Correspondence: Dr Warren Fong, Department of Rheumatol- ogy and Immunology, Singapore General Hospital, Academia Building, Level 4, 20 College Road, Singapore City 169856, Singapore. Email: warren.fong.w.s@singhealth.com.sg † Co-first authors © 2018 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd International Journal of Rheumatic Diseases 2018