Doctors and rheumatoid arthritis patients differ on perception of disease activity

July 18, 2012

Researchers from Austria have determined that patients with rheumatoid arthritis (RA) and their doctors differ on perception of RA disease activity. The study now available in Arthritis & Rheumatism, a journal of the American College of Rheumatology (ACR) and published by Wiley, reports that RA patients cite joint pain as the reason for their perception of a change in their disease activity. Rheumatologists, however, stressed joint swelling as the major determinant for their perception of change in RA disease activity.

RA is a systemic rheumatic disease that causes inflammation, pain, tenderness and swelling of the joints, which may limit functional activities and lead to permanent disability. This chronic condition is prevalent in up to 1% of the population worldwide, often striking women between 20 and 40 years of age and those in developed countries according to the World Health Organization (WHO). In the U.S., the ACR reports more than one million adults are affected by RA.

Treatment goals for RA aim to interfere with the inflammatory process and early intervention is recommended by experts. Moreover, the ACR and European League Against Rheumatism (EULAR) recently standardized criteria for measuring disease activity in RA, which were published in Care & Research and includes:

  • Clinical Disease Activity Index (CDAI)
  • Disease Activity Score with 28-joint counts (erythrocyte sedimentation rate or C-reactive protein) (DAS-28)
  • Patient Activity Scale (PAS)
  • PAS-II
  • Routine Assessment of Patient Index Data with 3 measures (RAPID 3)
  • Simplified Disease Activity Index (SDAI)
"Discussion of treatment options by patients and physicians is important in the management of RA," explains lead author Dr. Daniel Aletaha with Medical University Vienna in Austria. "Many times there is a discrepancy between patients' and doctors' views of disease activity, with providing a better rating than the patients." Currently patients may be asked to assess their disease using the patient global assessment (PGA) and rheumatologists typically measure RA disease with the evaluator global assessment (EGA).

Researchers identified 646 RA patients, who began treatment with methotrexate, from an observational patient database. Patients and physicians completed the PGA and EGA assessments, respectively, which the team used to analyze their determinants.

Results indicate that 78% of PGA variability and 67% of EGA variability could be explained by different measures in the RA patients: PGA variation is determined to about 76% by pain, 1.3% by function, and 0.5% by swollen joints. EGA variations were attributed to: 61% by swollen joints, 5% by pain, 0.6% by function, 0.4% by C-reactive protein, and 0.3% by tender joints.

Dr. Aletaha concludes, "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. The discrepancy of between patient and physician were calculated as PGA minus EGA. Pain levels and joint swelling are again explaining these discrepancies to a great deal." The authors suggest that further understanding of the reasons behind the differing views of could lead to improved shared decision making between and physicians in managing RA.

Explore further: ACR endorses standardized measures to determine rheumatoid arthritis disease activity

More information: "Discrepancies Between Patients and Physicians in the Perception of Rheumatoid Arthritis Disease Activity." Paul Studenic, Helga Radner, Josef S Smolen and Daniel Aletaha, Arthritis & Rheumatism; Published Online: July 18, 2012 (DOI: 10.1002/art.34543).

Related Stories

ACR endorses standardized measures to determine rheumatoid arthritis disease activity

April 2, 2012
A working group convened by the American College of Rheumatology (ACR) has evaluated more than 60 disease activity measures for rheumatoid arthritis (RA). The group narrowed the number of RA disease activity measures and ...

Achieving realistic physical activity goals benefits RA patients

August 25, 2011
Researchers from The Netherlands report that patients with rheumatoid arthritis (RA) who have higher levels of self-efficacy for physical activity are more likely to achieve their physical activity goals. According to the ...

Cancer screening rates comparable for those with and without rheumatoid arthritis

July 10, 2012
New research reveals that rheumatoid arthritis (RA) patients do not receive fewer cancer screening tests than the general population. Results of the study, funded in part by grants from the National Institutes of Health (NIH) ...

ACR updates guidelines for use of DMARDs and biologic drugs in treating rheumatoid arthritis

April 2, 2012
The American College of Rheumatology (ACR) has released the 2012 recommendations for the use of disease-modifying antirheumatic drugs (DMARDs) and biologic agents in the treatment of rheumatoid arthritis (RA). The guidelines ...

Recommended for you

Improving the recognition of anxiety and depression in rheumatoid arthritis

August 28, 2017
A study conducted by Keele University shows that patients with rheumatoid arthritis who are also suffering with anxiety or depression may avoid talking to their GP about their mental health symptoms.

How you think about your arthritis makes a difference

August 24, 2017
(HealthDay)—How well you cope with knee arthritis depends a lot on your mental outlook, a new study suggests.

Treating arthritis with algae

August 23, 2017
Researchers at ETH Zurich, Empa and the Norwegian research institute SINTEF are pursuing a new approach to treating arthritis. This is based on a polysaccharide, a long-chain sugar molecule, originating from brown algae. ...

Study shows prevalence of knee osteoarthritis has doubled since World War II

August 14, 2017
The average American today is twice as likely to be diagnosed with knee osteoarthritis than in the years before World War II, Harvard scientists say, but that increase can't be blamed on the reasons most might think.

Researchers find arthritis drug could treat blood cancer patients

August 3, 2017
Blood cancer sufferers could be treated with a simple arthritis drug, scientists at the University of Sheffield have discovered.

Fluid in the knee holds clues for why osteoarthritis is more common in females

June 26, 2017
Researchers have more evidence that males and females are different, this time in the fluid that helps protect the cartilage in their knee joints.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.