Rheumatologists more likely to underestimate impact of osteoarthritis than rheumatoid arthritis
Despite having a higher burden of disease, individuals with osteoarthritis (OA) are more likely to have their condition underestimated by rheumatologists than individuals with rheumatoid arthritis (RA), according to a study presented at the European League Against Rheumatism Annual Congress (EULAR 2016) held in London, UK.
To analyse the discordance between physician global estimates (DOCGL) and patient global estimates (PATGL) in patients with RA (n=216) or OA (n=243), patients were asked to complete a multidimensional health assessment questionnaire/routine assessment of patient index data (MDHAQ/RAPID3) while physicians used the RheuMetric checklist, both of which enabled evaluation of disease severity on a visual analogue scale (VAS). [EULAR 2016, abstract OP0094]
Patients with RA were more likely to be in concordance with their physicians (67 percent, n=144) compared to OA patients (56 percent; n=136).
Patient perception of disease severity exceeded that of physician perception (PATGL>DOCGL) in 82 OA patients (34 percent) and 39 (18 percent) RA patients, while physician perception was higher than patient perception of disease severity (DOCGL>PATGL) in 33 RA (15 percent) and 25 OA patients (10 percent).
There was an almost two-fold greater likelihood that rheumatologists would underrate OA compared to RA, said study author Dr. Isabel Castrejón from the Rush University Medical Center, Chicago, Illinois, US who presented the results.
In both diagnosis groups, higher perception of disease severity was more likely in patients with lower education levels, higher levels of pain, disability, fatigue, and joint counts, and more symptoms. Experiencing higher levels of pain was found to be a significant predictor of discordance for both diagnosis groups, said Castrejón.
Previous studies have pointed to discordance between patient and physician assessment of rheumatic disease severity. [Arthritis Care Res (Hoboken) 2014;66:934-942; Arthritis Care Res (Hoboken) 2012;64:206-214]
“Concordance by patients and physicians has been associated with greater expectations for improvement and better outcomes. It is important to be able to recognize discordance by patients and physicians because that can influence treatment adherence, compliance, and future outcomes,” said Castrejón.“RA is generally thought to be more severe than OA, not only by physicians but also by patients and the public,” said Castrejón. “Rheumatologists need to revise their generally held views that OA is less severe than RA,” she said, while stressing on the importance of good communication between patients and physicians.