Impact of Osteoarthritis Underrated by Rheumatologists

Pam Harrison

June 08, 2016

LONDON, United Kingdom — Rheumatologists are significantly more likely to underestimate the impact of osteoarthritis than rheumatoid arthritis, even though patients with osteoarthritis often have more pain and a greater burden of disease than patients with rheumatoid arthritis, new research shows.

"Rheumatologists have to revise the generally held view that osteoarthritis is less severe than rheumatoid arthritis," Isabel Castrejon, MD, from the Rush University Medical Center in Chicago, said during a news conference here at the European League Against Rheumatism (EULAR) Congress 2016.

"Discordance between a physician's perception of disease severity and a patient's perception is important because of the negative impact it can have on shared decisions concerning the best choice of therapy," she explained. "But studies have shown that physicians consistently underrate the severity of many rheumatic diseases, including osteoarthritis."

In this study, 243 patients with osteoarthritis and 216 patients with rheumatoid arthritis from a routine rheumatology academic setting completed a multidimensional health assessment.

Patients evaluated their disease severity on a 10 cm visual analogue scale. They also scored themselves on measures of physical function, pain, and fatigue, and completed a symptom checklist.

Physicians used the same visual analogue scale to rate patients' disease severity.

Studies have shown that physicians consistently underrate the severity of many rheumatic diseases, including osteoarthritis.

A difference of 2 cm or more on the visual analogue scale between patient and physician ratings was considered a sign that rheumatologists were underestimating the impact of the disease.

Disease severity was underestimated by rheumatologists more often in osteoarthritis patients than in rheumatoid arthritis patients (34% vs 18%).

Ratings of disease severity from patients and physicians were similar in slightly more than half of osteoarthritis patients and in about two-thirds of rheumatoid arthritis patients.

There was no difference in age between the two patient groups. And in both groups, "patients with a higher perception of disease severity had higher levels of pain, disability, and fatigue, and more symptoms," Dr Castrejon reported.

In both groups of patients, a higher level of pain was a significant predictor of an underestimation of disease severity by rheumatologists.

Dr Castrejon explained that there might have been less discordance between patient and physician ratings of disease severity if the physicians had been orthopedic surgeons.

"I think that physicians' perspectives can be completely different, depending on their specialty," she told Medscape Medical News.

It is possible that orthopedic surgeons see osteoarthritis patients toward the later stages of disease, "so they see more severe disease. That could possibly lead to better concordance with patient ratings," she suggested.

For patients with rheumatoid arthritis, which is a progressive disease, rheumatologists can keep trying new drugs in succession to "treat to target," as is recommended by the guidelines, she pointed out. In contrast, "there is no treat to target for osteoarthritis."

A "Neglected Disease"

Osteoarthritis is often a "neglected disease," said EULAR President Gerd Burmester, MD, from Charité Universitätsmediz in Berlin.

This is a problem, given that almost everyone develops some form of the disease as they age. In Europe, it is estimated that nearly twice as many women as men older than 60 years have osteoarthritis.

"People think that rheumatoid arthritis is a very important disease and that osteoarthritis is trivial and there is nothing we can do about it," said Dr Burmester. "This is simply not true, and this study underlined that."

The key to treating osteoarthritis might well be to take a multidisciplinary team approach, in which patients have access to a range of physicians and therapists, or at least access to some form of physical therapy, he said.

"If you have a team of professionals, you can treat at least some forms of osteoarthritis well," Dr Burmester explained.

"It is really important to be aggressive with osteoarthritis," said Dr Castrejon. "It's important to advise patients to be active, to exercise as much as they can, and be mindful that obesity is more strongly related to osteoarthritis than rheumatoid arthritis. There are strategies that we can use to help improve quality of life for patients with osteoarthritis."

Dr Castrejon and Dr Burmester have disclosed no relevant financial relationships.

European League Against Rheumatism (EULAR) Congress 2016: Abstract OP0094. Presented June 8, 2016.

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