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RA Patients and Physicians Differ on Disease Severity

Last Updated: June 02, 2010.

Nearly one-third of rheumatoid arthritis patients assess the severity of their disease differently than their rheumatologists do, with the disparity most pronounced for patients with higher depressive symptoms, according to a study in the June issue of Arthritis Care & Research.

WEDNESDAY, June 2 (HealthDay News) -- Nearly one-third of rheumatoid arthritis (RA) patients assess the severity of their disease differently than their rheumatologists do, with the disparity most pronounced for patients with higher depressive symptoms, according to a study in the June issue of Arthritis Care & Research.

Jennifer L. Barton, M.D., of the University of California in San Francisco, and colleagues had 223 adult patients with RA and their rheumatologists separately assess global disease severity using a 100 mm visual analogue scale (VAS). The researchers gathered information on patient demographics and each patient's health and mental health status using the Health Assessment Questionnaire, Disease Activity Score 28, and Patient Health Questionnaire 9 (PHQ-9) depression scale. They identified predictors of positive discordance for RA severity, defined as a patient rating 25 mm or more higher than the rheumatologist rating.

The researchers observed discordance in 31 percent of cases, with a mean difference between patient and physician assessment of 46 mm on the VAS. The strongest predictor of discordance was a five-point increase in score on the PHQ-9 depression scale, while those with a greater number of swollen joints and speakers of the Cantonese/Mandarin language had the lowest discordance.

"Nearly one-third of RA patients differed from their physicians to a meaningful degree in assessment of global disease severity. Higher depressive symptoms were associated with discordance. Further investigation of the relationships between mood, disease activity, and discordance may guide interventions to improve care for adults with RA," the authors write.

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