1.0), fatigue (version 1.0), and ability to participate in social roles and activities (version 2.0). Each PROMIS instrument has eight items, rated by patients as 1 through 5, and total scores are obtained for each of the four instruments separately. The Health Assessment Questionnaire II (HAQ-II) is a widely used, reliable, and valid 10-item questionnaire that measures functional status [19]. Certified rheumatologist sonographers (TB, KW, and JMD), to whom the clinical status of patients was masked, performed ultrasonographic examination of the clinically dominant hand and foot, including second and third proximal interphalangeal joints, second and third metacarpophalangeal joints, wrist, and second and fifth metatarsophalangeal joints, according to the German Ultrasound 7 score [20,21,22]. This method scores gray scale (GS) and power Doppler (PD) synovitis semiquantitatively (score, 0–3), as well as the presence of GS and PD tenosynovitis and erosions. Its scoring ranges are 0 to 27 for GS synovitis, 0 to 39 for PD synovitis, 0 to 7 for GS tenosynovitis, 0 to 21 for PD tenosynovitis, and 0 to 14 for erosions. These examinations were generally performed on the same day as the questionnaires. Descriptive statistics (e.g., median, percentage) were used to summarize the data. Comparisons between the total discordant group and total concordant group and stratifications with LDA versus MHDA categories were performed using χ2 and rank sum tests. Multivariable logistic regression models of discordance compared with concordance were also used. Expert consensus was used to select a priori the list of variables to include in the multivariable model. Analyses were performed with SAS software version 9.4 (SAS Institute Inc.). The study cohort included 350 consecutive patients (mean age, 63.5 years; female, 70%) with mean disease duration of 7.7 years (Table 1). Patient-provider discordance, defined by an absolute difference of ≥ 25 points between the patient and provider global assessments (Fig. 1), occurred in 114 (32.5%) of the patients, and 103 patients (29.4%) rated their global assessments higher than their providers. The 11 patients who recorded their global assessments lower than their providers were excluded from further analysis. Thus, the study focused on the 103 patients in the discordant group and 236 patients in the concordant group. Association of patient characteristics with patient-provider discordance in global assessments of disease activity in the total study population Distribution of the continuous differences between the patient and provider global assessments of disease activity in the overall study population The rheumatology provider at the most recent clinical visit of a patient was a nurse practitioner or physician assistant for 230 patients (68%), attending physician for 90 (27%), and a fellow for 19 (6%), with no significant differences between the discordant and concordant groups (Table 1). The discordant group had a higher median global assessment of disease activity than the concordant group (57 vs. 20; P < .001), whereas provider global assessments were similar between the groups. According to the CDAI, a smaller proportion of patients in the discordant group was in remission than in the concordant group (2% vs. 33%), and greater proportions of patients in the discordant group were in LDA (50% vs. 33%) and MDA (37% vs. 22%) categories than in the concordant groups (P < .001), while proportions of patients with HDA were similar