Impact of OA Underestimated?

New research from Rush University Medical Center indicates that osteoarthritis (OA) patients are more likely to have the impact of their condition underestimated by rheumatologists than patients with rheumatoid arthritis (RA). The study was recently presented at the European League Against Rheumatism Annual Congress (EULAR 2016).

“This discordance between physician and patient perception of disease severity is important because of the negative impact it can have on shared decisions concerning the best choice of therapy, ” said lead author Isabel Castrejon, M.D., Ph.D. from Rush University Medical Center, in the June 8, 2016 news release. “This in turn is likely to interfere with treatment compliance and future outcomes, ” Dr. Castrejon explained.

As indicated in the news release, “In this new study, patient perception of disease severity was greater than physician assessment (by two Units or more) in one third of 243 OA patients and one fifth of 216 RA patients. The assessments of severity were equivalent in just over one half of OA and two thirds of RA patients. Physician evaluation of severity was greater than patient assessment (by two Units or more) in 10% of OA and 15% of RA patients. Physician and patient evaluation of disease severity are both based on a 0-10 visual analogue scale; patient assessment included completion of a multidimensional health assessment questionnaire, with scores for physical function, pain and fatigue, a symptom checklist, and a self-reported joint count.”

Dr. Castrejon told OTW, “Discordance of assessments between patients and their physicians occurs when both assign different values to patients’ global health estimate. Although this study was performed only with rheumatologists, discordance may be present also between orthopedic surgeons and their patients with osteoarthritis. Physicians and patient’s concordance is desirable in shared decisions not only for rheumatologists but also for other specialties because it has been associated with greater expectations for improvement and better outcomes.”

Asked what can be done about these discrepancies in perception, she added, “In most of the studies published analyzing discordance, it has been seen that when rating their global status, patient assessments were more strongly associated with pain, physical function, and psychological well being regarded as ‘subjective symptoms’ by most clinicians, while physicians’ assessment were more strongly associated with other clinical findings, mainly laboratory test. Although these symptoms may be regarded as subjective they are important for the patient and may affect future outcomes. For example, physical function is a strong predictor of mortality not only in RA but also in the general population. Nowadays there is increased emphasis on ‘patient-centered care’ that gives due importance to patient’s perception of health and considers their priorities and preferences in making therapeutic decisions. This ‘patient-centered care’ may help to decrease the level of discordance and improve future outcomes.”