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Doctors and rheumatoid arthritis patients differ on perception of disease activity

RA patients emphasize pain, physicians stress swollen joints to explain change in disease

Researchers from Austria have determined that patients with rheumatoid arthritis (RA) and their doctors differ on perception of RA disease activity. The study now available in Arthritis & Rheumatism, a journal of the American College of Rheumatology (ACR) and published by Wiley, reports that RA patients cite joint pain as the reason for their perception of a change in their disease activity. Rheumatologists, however, stressed joint swelling as the major determinant for their perception of change in RA disease activity.

RA is a systemic rheumatic disease that causes inflammation, pain, tenderness and swelling of the joints, which may limit functional activities and lead to permanent disability. This chronic condition is prevalent in up to 1% of the population worldwide, often striking women between 20 and 40 years of age and those in developed countries according to the World Health Organization (WHO). In the U.S., the ACR reports more than one million adults are affected by RA.

Treatment goals for RA aim to interfere with the inflammatory process and early intervention is recommended by experts. Moreover, the ACR and European League Against Rheumatism (EULAR) recently standardized criteria for measuring disease activity in RA, which were published in Arthritis Care & Research and includes:

Clinical Disease Activity Index (CDAI)
Disease Activity Score with 28-joint counts (erythrocyte sedimentation rate or C-reactive protein) (DAS-28)

Patient Activity Scale (PAS)

Routine Assessment of Patient Index Data with 3 measures (RAPID 3)
Simplified Disease Activity Index (SDAI)
"Discussion of treatment options by patients and physicians is important in the management of RA," explains lead author Dr. Daniel Aletaha with Medical University Vienna in Austria. "Many times there is a discrepancy between patients' and doctors' views of disease activity, with doctors providing a better rating than the patients." Currently patients may be asked to assess their disease using the patient global assessment (PGA) and rheumatologists typically measure RA disease with the evaluator global assessment (EGA).

Researchers identified 646 RA patients, who began treatment with methotrexate, from an observational patient database. Patients and physicians completed the PGA and EGA assessments, respectively, which the team used to analyze their determinants.

Results indicate that 78% of PGA variability and 67% of EGA variability could be explained by different measures in the RA patients: PGA variation is determined to about 76% by pain, 1.3% by function, and 0.5% by swollen joints. EGA variations were attributed to: 61% by swollen joints, 5% by pain, 0.6% by function, 0.4% by C-reactive protein, and 0.3% by tender joints.

Dr. Aletaha concludes, "Our study shows pain really drives patient perception of disease activity, while physicians mostly rely on the number of swollen joints when they interpret a patient's disease activity. The discrepancy of perception between patient and physician were calculated as PGA minus EGA. Pain levels and joint swelling are again explaining these discrepancies to a great deal." The authors suggest that further understanding of the reasons behind the differing views of disease activity could lead to improved shared decision making between patients and physicians in managing RA.

This study is published in Arthritis & Rheumatism. Media wishing to receive a PDF of this article may contact

Full Citation: "Discrepancies Between Patients and Physicians in the Perception of Rheumatoid Arthritis Disease Activity." Paul Studenic, Helga Radner, Josef S Smolen and Daniel Aletaha, Arthritis & Rheumatism; Published Online: July 18, 2012 (DOI: 10.1002/art.34543).

About the Author: To arrange an interview with Dr. Daniel Aletaha, please contact Thorsten Medwedeff at

About the Journal:

Arthritis & Rheumatism is an official journal of the American College of Rheumatology (ACR) and the Association of Rheumatology Health Professionals (ARHP), a division of the College, and covers all aspects of inflammatory disease. The American College of Rheumatology ( is the professional organization who share a dedication to healing, preventing disability, and curing the more than 100 types of arthritis and related disabling and sometimes fatal disorders of the joints, muscles, and bones. Members include practicing physicians, research scientists, nurses, physical and occupational therapists, psychologists, and social workers. The journal is published by Wiley on behalf of the ACR. For more information, please visit .

About Wiley

Founded in 1807, John Wiley & Sons, Inc. has been a valued source of information and understanding for more than 200 years, helping people around the world meet their needs and fulfill their aspirations. Wiley and its acquired companies have published the works of more than 450 Nobel laureates in all categories: Literature, Economics, Physiology or Medicine, Physics, Chemistry, and Peace.

Our core businesses publish scientific, technical, medical, and scholarly journals, encyclopedias, books, and online products and services; professional/trade books, subscription products, training materials, and online applications and Web sites; and educational materials for undergraduate and graduate students and lifelong learners. Wiley's global headquarters are located in Hoboken, New Jersey, with operations in the U.S., Europe, Asia, Canada, and Australia. The Company's Web site can be accessed at The Company is listed on the New York Stock Exchange under the symbols JWa and JWb.

Media Advisory

2012 ACR/ARHP Annual Meeting Press Registration Now Open.

What: Press registration is now open to journalists planning to attend the 2012 ACR/ARHP Annual Meeting

Where: Walter E. Washington Convention Center; Washington, D.C.

When: November 10 - 14, 2012

Policies: Please make sure to review our press guidelines as they may impact your ability to receive press credentials

Registration: To register for a press pass, please visit

Key dates:
Press registration closes: Monday, October 29, 2012
Press conference schedule announced: September
On-site Newsroom opens: Saturday, November 10, 2012
Opening Lecture/Embargo lifts: 4:30 PM Eastern Time on Saturday, November 10, 2012

Contact: Suzanne Forte,, 404-633-3777

Headquartered in Atlanta, Ga., the American College of Rheumatology is an international professional medical society that represents more than 8,500 rheumatologists and rheumatology health professionals. Rheumatologists are internists or pediatricians who are qualified by training and experience in the diagnosis and treatment of arthritis and other diseases of the joints, muscles and bones. Over 50 million Americans - including nearly 300,000 children - suffer from the painful, disabling and sometimes fatal effects of arthritis and rheumatic diseases. The ACR's mission is to advance rheumatology. Learn more by visiting or follow ACR on Twitter at

Dawn Peters | EurekAlert!
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