Many Patients Feel Far Worse Than Their Rheumatologists Perceive

Dec 13, 2013

Patients with rheumatic disorders tend to rate their global health status considerably lower than their doctors do using the same standard questionnaire. This discordance may have implications for the effectiveness of treatments.

Castrejón I, Yazici Y, Samuels J, Luta G, Pincus T. Discordance of global estimates by patients and their physicians in usual care of many rheumatic diseases is associated with 5 MDHAQ scores not found on the HAQ. Arthritis Care Res. (2013) doi: 10.1002/acr.22237. Published online ahead of print.

Patients with rheumatic diseases often report poorer health status than their doctors perceive, which could lead to inappropriate treatment, researchers say.

A 6-year study of 980 random patients (the majority female, mean age 52) found that 38% of patients indicated worse global health than their physicians estimated.

Patients completed the multidimensional health assessment questionnaire (MDHAQ) during a regular visit to the New York University Hospital for Joint Diseases in New York City.

The discordance rates were similar among patients patients diagnosed with rheumatoid arthritis (n=145), osteoarthritis (n=173), systemic lupus erythematosus (n=57), or other inflammatory diseases such as SjÓ§gren’s syndrome and non-inflammatory rheumatic conditions like fibromyalgia (n=348/257).

The authors suggest that patients may have a greater perception of pain and fatigue than their doctors recognize. The study also showed  discordance in assessments of variables such as sleep quality, depression, and fatigue and sore joint counts, which are not included in the questionnaire.

“A patient who overestimates severity may push a doctor to initiate treatments which may have a poor risk/benefit ratio," note the authors. "By contrast, patients who underestimate severity may have poor adherence to treatment and/or may lead their physicians to underrate the impact of disease.”

Patients whose global estimates were higher than those of their doctors were more likely to be older, female, of Hispanic ethnicity, to have less formal education, and not to be employed full-time.

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