Different Views on RA Disease Activity

Joint pain and joint swelling are two of the main ways to measure disease activity in people with rheumatoid arthritis. Doctors and patients may disagree on which measure is more important.

Joint pain is generally how rheumatoid arthritis patients notice changes in their disease activity.

Doctors, on the other hand, usually focus on joint swelling as a sign of changes in arthritis disease activity.

Work with your doctor to decide the best arthritis treatment.

According to Daniel Aletaha, MD, of the Medical University Vienna in Austria and lead author of the study, patients' views of disease activity often differ from those of doctors, with doctors seeing more improvement than patients.

Typically, rheumatologists measure rheumatoid arthritis activity using the evaluator global assessment (EGA), while patients may be asked to rate their arthritis activity with the patient global assessment (PGA).

Dr. Aletaha and colleagues wanted to see why EGA and PGA scores were frequently different.

They found that different measures of rheumatoid arthritis activity accounted for about 67 percent of the EGA variability. More specifically, doctors rated disease activity based on swollen joints 61 percent of the time; on pain 5 percent of the time; on function 0.6 percent of the time; on C-reactive protein levels 0.4 percent of the time; and on tender joints 0.3 percent of the time.

Different measures of disease activity accounted for about 78 percent of the PGA variability. That is, patients rated disease activity based on pain 76 percent of the time; on function 1.3 percent of the time; and on swollen joints 0.5 percent of the time.

"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," said Dr. Aletaha.

Gaining a better understanding of why doctors and patients differ on their view of disease activity could improve the way doctors and patients make treatment and management decisions together, the authors suggested.

The study included 646 rheumatoid arthritis patients who started treatment with methotrexate.

The research was published July 18 in Arthritis & Rheumatism.