Background Concordance between global estimates of clinical status by physicians and patients may influence shared decisions concerning therapy toward better compliance and outcomes. However, discordance has been described in most rheumatology settings in which it has been studied carefully1,2. While osteoarthritis (OA) generally is regarded as a less severe medical problem than rheumatoid arthritis (RA), recent evidence suggests similar disease burdens in both OA and RA.
Objectives To analyze discordance between physician global estimates (DOCGL) and patient global estimates (PATGL) in OA vs RA patients seen in a routine rheumatology academic setting.
Methods In this setting, all patients complete a multidimensional health assessment questionnaire/routine assessment of patient index data (MDHAQ/RAPID3), which includes 0–10 scores for physical function, pain, and PATGL compiled into a 0–30 RAPID3, as well as fatigue VAS, a symptom checklist, and a RADAI self-report joint count, and demographic data. Patients with primary diagnoses of OA or RA were classified into 3 categories: PATGL≥DOCGL by 2/10 units, PATGL=DOCGL, and DOCGL≥PATGL by 2 units. The percentage of patients in each group was compared between RA and OA using chi-square. Variables were compared using ANOVA.
Results The study included 216 patients with RA, 39 (18%) were discordant with PATGL>DOCGL and 243 patients with OA, 82 (34%) were similarly discordant. Concordance with PATGL=DOCGL was seen in 144 patients (67%) with RA and 136 patients (56%) with OA, while discordance with DOCGL>PATGL was seen in 33 patients (15%) of patients with RA and 25 (10%) with OA (p<0.001). Age did not differ in the groups, other than older patients with OA (72.6 yrs) curiously were among the fewer OA patients who were more likely to show DOCGL>PATGL than younger patients with OA (64.6–64.8 yrs). Patients with PATGL>DOCGL had lower formal education levels (p<0.05 in RA but not OA). Other MDHAQ measures were higher in OA patients than in RA patients with (Table). Highest MDHAQ scores were seen in patients with PATGL>DOCGL than in PATGL=DOCGL than in DOCGL>PATGL (p<0.001 other than symptoms and RADAI).
Conclusions Patients with OA are more likely to have their clinical status underestimated by rheumatologists than patients with RA, although the burden of disease in OA in these patients was greater than in RA. These data suggest a need to revise generally held views that OA is less severe than RA.
Arthritis Care Res (Hoboken) 2014;66:934–42.
Arthritis Care Res (Hoboken) 2012;64:206–14.
Disclosure of Interest I. Castrejon: None declared, J. Chua: None declared, J. Block: None declared, T. Pincus Shareholder of: Health Report Services, Inc