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Rheumatologists, dermatologists, patients differ on skin symptom severity
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Rheumatologists are more likely to emphasize joint symptoms in patients with psoriatic disease, whereas dermatologists are more likely to perceive skin symptoms as bothersome — and both often differ with patients regarding the severity of painful skin — according to findings published in Arthritis Research and Therapy.
“Patient-centered care is becoming a shared decision making are becoming important tenants in healthcare delivery,” Brett Hauber, PhD, of RTI Health Solutions, told Healio Rheumatology. “This study identifies areas in which physicians and patients may have different perspectives on priorities for treatment. In addition, in psoriatic disease, with manifestations of both skin and joint involvement, a patient could be treated by different physician specialists and these specialists may differ in their perspectives about treatment priorities. Identifying these differences highlights areas in which additional communication between patients and physicians could result in treatments that better address the needs of patients.”
To compare how rheumatologists, dermatologists and patients characterize and perceive symptoms of psoriatic disease, the researchers distributed online surveys to 16,624 individuals through the Nielsen Company. The 20-item surveys used object-case best-worst scaling, and asked patients to identify the most and least bothersome symptoms from a set of 5.
Each of the 20 items in the survey described psoriatic disease skin and joint symptoms and effects on patients’ daily life. The researchers analyzed the responses using random-parameters logit models for each group — patients, rheumatologists or dermatologists — creating a relative-bother weight (RBW) for each item compared with joint pain, soreness or tenderness. A total of 200 patients, 150 rheumatologists and 150 dermatologists completed the survey.
According to the researchers, patients and physicians agreed that “joint pain, soreness and tenderness” were among the most bothersome symptoms of psoriatic disease, with an RBW score of 1 for all three. However, patient characterized “painful, inflamed or broken skin” as more bothersome, with an RBW of 1.03, whereas both sets of physicians saw painful skin as less noteworthy — with rheumatologists producing an RBW of 0.17 and dermatologists producing an RBW of 0.22 — than joint pain. Compared with joint pain, rheumatologists were more likely to characterize other joint symptoms as bothersome, whereas dermatologists were more likely to perceive other skin symptoms as aggravating.
“Even though patients, dermatologists, and rheumatologists all agree that addressing joint pain and stiffness is among the highest priorities, the results of this study suggest that patients consider certain skin symptoms to be at least as important as joint symptoms, while both dermatologists and rheumatologists may perceive skin symptoms to be relatively less important,” Hauber said. “This difference in priorities underscores the need for shared decision making to ensure that patients receive the treatment that most meets their needs.” – by Jason Laday
Disclosure: Hauber reports employment with RTI Health Solutions, which has received consulting fees from AbbVie. Please see the study for all other authors’ relevant financial disclosures.
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