Cecile Gaujoux-Viala MD, PhD, at the American College of Rheumatology (ACR)

Why do rheumatoid arthritis patients so often see their condition differently from the way their doctors see it?

Perhaps it’s because doctors aren’t looking at the big picture. Physicians seldom consider such factors as fatigue, depression and social support when they evaluate their patients, says Cécile Gaujoux-Viala, MD, PhD, of the Department of Rheumatology, Nîmes University Hospital in Nîmes, France.

The disconnect between patients’ and physicians’ perceptions is getting more attention because of improved medications. Organizations of rheumatologists like the American College of Rheumatology (ACR) now recommend that doctors and patients work toward the goal of remission. But patients and their doctors don’t always agree when they’ve reached that point.

To delve into this difference in perception, Gaujoux-Viala and her colleagues compared the way patients scored themselves to the way physicians scored their patients.

The patients used the Patient’s Global Assessment, where they answer the question, “Considering all of the ways your arthritis has affected you, how do feel your arthritis is today?” Patients mark their status on a line from 0 to 100 millimeters where zero is perfect health and 100 is near death. Physicians rate their patients’ condition on a similar scale, the Evaluator’s Global Assessment.

Comparing the two scales for 645 patients with early rheumatoid arthritis, Gaujoux-Viala and her colleagues found that patients and physicians agreed when patients who were doing really well or really poorly.

But there was a lot of disagreement in the middle. And when they disagreed, it was usually because patients rated their condition worse than their physicians did. On average, the patients rated their condition a 62 while physicians rated their patients a 54.

There were exceptions. Occasionally patients thought they were doing OK while their physicians thought they weren’t.

To understand the reasons for these differences, the researchers collected details about the patients and their disease.

They found that differences between patients and physicians assessments were particularly likely when the patients were doing well by the criteria that physicians traditionally use, such as the number of swollen joints.

The differences in perception were also likely when patients lived alone, or felt fatigued or depressed.

Gaujoux-Viala thinks doctors should pay more attention to patients’ environments and emotions. They could do this simply by spending more time talking with their patients, or perhaps giving patients a few days to digest the news of a diagnosis before trying to give information about treatments.

And she thinks researchers need to investigate further. “If you understand why there is discordance on disease activity, it will contribute to shared decision making,” she said.