Discrepancy in Perception of RA Disease Activity Elucidated

RA patients see pain, doctors see joint swelling as the primary determinant of disease activity

THURSDAY, July 19 (HealthDay News) -- Patients with rheumatoid arthritis (RA) see pain as the most significant determinant of their disease activity, while physicians see joint swelling as the most important determinant, according to a study published online July 18 in Arthritis & Rheumatism.

Paul Studenic, of the Medical University in Vienna, and colleagues conducted a study involving 646 patients with RA who began treatment with methotrexate and for whom both a patient global assessment (PGA) and an evaluator global assessments (EGA) were available. The extent and reasons for discrepancies in these measures were explored.

The researchers found that the majority of PGA variability (77.4 percent) and EGA variability (66.7 percent) was explainable. For PGA, pain (75.6 percent), function (1.3 percent), and swollen joints (0.5 percent) were the main determinants, whereas for EGA, the primary determinants were swollen joints (60.9 percent), pain (4.5 percent), function (0.6 percent), C-reactive protein (0.4 percent), and tender joints (0.3 percent). Pain and swollen joints explained 65 percent of the discordance between patients and physicians. Changes in pain and swollen joints accounted for 34.6 and 12.5 percent of the variability, respectively, in the discrepancy in perception of changes in RA disease activity.

"In conclusion, the results of our study call for the awareness that general perception of disease activity uses a different perspective if done by patients as compared to physicians," the authors write. "In addition, it is a call to treat non-inflammatory pain, as this may create better consensus about the course of treatment."

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