Awareness of supporting evidence 'vital' to debunking popular patient myths
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To avoid perpetuating misinformation regarding rheumatic diseases, rheumatologists should ensure they are aware of the available evidence – or lack thereof – for some of the popular myths patient hold about their disease, noted a speaker at the EULAR 2021 Congress.
Mariano Andres, MD, PhD, of Hospital General Universitario de Alicante-ISABIAL, and of Miguel Hernandez University in Alicante, Spain, highlighted the importance of making evidence-based decisions as a clinician. “Not all decisions are evidence-based, unfortunately,” he said.
One reason for this may be a lack of clinical trial or post-marketing data from which to draw. But even where data exists, bias also exists. Andres noted gender and socioeconomic bias as being commonly found in bodies of research.
“Despite the lack of evidence, we still need to make decisions,” he said. “So, we need to search for information. We can use our own experience, we can use the experience from colleagues or experts — so-called eminence-based medicine — or we can use our own beliefs or those in the popular culture.”
It follows, then, that when these sources of information are used, the risk of myths and misinformation increases.
Andres framed his talk in terms of two questions frequently asked by patients. One pertained to whether the weather impacts rheumatology patients. The other was whether knuckle cracking leads to osteoarthritis.
While the impact of weather is reported to be “modest,” Andres noted that some 60% to 70% of patients with rheumatic diseases believe the weather impacts their disease. This phenomenon is more common among women. “Interestingly, this effect is absent in healthy controls,” he said.
Some data show that while the temperature seems to carry no clear association with pain scores in patients with rheumatic diseases, humidity, wind and atmospheric pressure may correlate with pain. Patients with rheumatoid arthritis and OA have experienced this phenomenon to somewhat consistent effect, while associations between the weather and fibromyalgia, juvenile idiopathic arthritis, spondyloarthritis and gout are less clear.
“However, all of these papers survey the patients and there can be reporting bias,” Andres said.
That said, Andres noted historical clinical trial data from the physician Joseph Lee Hollander, who built a weather chamber at the University of Pennsylvania and had 12 patients with arthritis live in it for 2 weeks. The researchers were able to change the temperature, humidity, pressure and other factors, eventually showing a modest effect of the weather on patients.
So, as for the question about the weather and its impact on patients, Andres offered a clear answer. “I would say this is true, actually,” he said.
Regarding knuckle cracking and OA, Andres pointed to multiple studies showing that while hand swelling may increase and grip strength may decrease in frequent crackers, it had no impact on the likelihood of OA development. However, reporting bias was found in these trial results. Andres suggested that the jury is still out on the myth of knuckle cracking and OA.
“Evidence-based decisions have critically contributed to outcomes in clinical practice and society,” Andres concluded. “The absence of evidence increases the risk of receiving or using false or imprecise data. It remains vital verifying through the scientific method all received information.”
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Andres M. Is there misinformation in rheumatology? Presented at EULAR 2021 Congress; June 2-6, 2021 (virtual meeting).
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