RA Patients Emphasize Pain, Physicians Stress Swollen Joints to Explain Change in Disease
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 Arthritis
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 doctors
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 perception 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 disease activity could lead to improved shared decision making
between patients and physicians in managing RA.
