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Physicians, patients differ on perception of RA disease activity

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Patients with rheumatoid arthritis differ from physicians on their perceptions of disease activity, with patients citing joint pain as a motivating factor for perception of change and physicians stressing joint swelling as a major determinant, according to a study published in Arthritis & Rheumatism.

“Discussion of treatment options by patients and physicians is important in the management of RA [rheumatoid arthritis],” study author Daniel Aletaha, MD, MSc, stated in a press release. “Many times there is a discrepancy between patients’ and doctors’ views of disease activity, with doctors providing a better rating than the patients.”

Aletaha and his colleagues identified 646 patients with RA who underwent methotrexate treatment, looking at variance components for patient global assessment (PGA) and evaluator global assessment (EGA). Predictors of observed discrepancies were analyzed.

According to the study abstract, 77.4% of the PGA variability and 66.7% of the EGA variability within the cohort was explainable, with the main PGA determinants being pain (75.6%), function (1.3%) and swollen joints (0.5%) and the main EGA determinants being swollen joints (60.9%), pain (4.5%), function (0.6%), C-reactive protein (0.4%) and tender joints (0.3%).

Pain, according to the abstract, led to a discrepancy toward worse patient perception, with the opposite being true for swollen joints, which the authors noted accounted for 65% of the discordance between physicians and their patients. Changes in pain and swelling were also found to be main determinants for a discrepancy in the perception of changes regarding RA disease activity.

“Our study shows pain really drives patient perception of disease activity, while physicians mostly rely on the number of swollen joints when they interpret a patient’s disease activity,” Aletaha stated, further suggesting that more understanding of the reasons behind these differing views could lead to improved decision making between patients and physicians in managing RA.

Reference:

Studenic P, Radner H, Smolen JS, Aletaha D. Discrepancies between patients and physicians in the perception of rheumatoid arthritis disease activity. Arthritis Rheum. 2012. doi: 10.1002/art.34543