Evaluating RA disease severity: Patients and physicians do not see eye to eye

July 28, 2010

Close to one-third of patients with rheumatoid arthritis (RA) differ from their physicians in their assessment of disease severity, according a University of California, San Francisco study. Researchers found that patients who have depressive symptoms or poor overall function disagree with their physicians in their evaluation of RA activity more frequently than those who do not.

Close to one-third of patients with rheumatoid arthritis (RA) differ from their physicians in their assessment of disease severity, according a University of California, San Francisco study. Researchers found that patients who have depressive symptoms or poor overall function disagree with their physicians in their evaluation of RA activity more frequently than those who do not. An accurate assessment of RA activity is essential to determining the severity of disease and monitoring response to treatment and is particularly important with the advent of effective but potentially toxic therapies, the researchers suggested.

Clinicians who treat patients with diabetes mellitus or hypertension have a gold standard diagnostic measure (blood glucose test or blood pressure test) to evaluate disease activity accurately, according to the researchers. However, those who treat patients with RA rely on subjective measures (eg, patient self-report) and objective measures (eg, physician-assessed joint counts and acute phase reactant levels).

The researchers found clinically meaningful differences between patient and physician assessments of RA disease severity in 36% of patients; 30% of patients exhibited major depression and had greater odds of discordance with their physicians than those who were not depressed. The researchers saw a lower level of patient-physician discordance in patients who had a higher swollen joint count, but discordance persisted in patients who had poorer functional status.

Clear patient-physician communication in symptom reporting and assessment of disease activity is central to RA management, and reducing patient-physician discordance can improve patient outcomes, the researchers concluded, noting that further investigation of the relationships between mood, disease activity, and discordance may help guide interventions for improved RA patient care. Study details are published in the June issue of Arthritis Care & Research, a journal of the American College of Rheumatology.