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Depressed RA Patients Disagree With Doctors

Doctor-Patient Disagreements Can Affect Treatment and Outcome of Rheumatoid Arthritis
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WebMD Health News
Reviewed by Laura J. Martin, MD

May 27, 2010 -- Depressed patients with rheumatoid arthritis (RA) are more likely than those without mood disorders to disagree with their doctors about the symptoms and treatment of their physical aches and pains, according to a new study.

Researchers at the University of California, San Francisco say nearly a third of patients with rheumatoid arthritis disagree with their doctors about the severity of their disease.

And doctor-patient disagreement, the researchers say, is most common in patients who also are struggling with symptoms of depression.

The study is published in the June issue of Arthritis Care & Research, a journal of the American College of Rheumatology.

Rheumatoid arthritis is an autoimmune disease characterized by painful swelling of the lining of the joints; it affects up to 2 million Americans -- twice as many women as men.

Rheumatologists often rely on self-reports of patients along with some objective measures to determine the severity of the disease, which is critical for adequate treatment.

Researchers recruited 233 people from the University of California, San Francisco Rheumatoid Arthritis Cohort, a study group, who had a mean age of 53, and of whom 88% were women.

The researchers gathered clinical information on each person, including data on tender and swollen joints, functional status, symptoms of depression, and opinions of patients about the severity of their disease.

"We found clinically meaningful differences between patient and physician assessments of RA disease severity in 36% of cases," study researcher Jennifer L. Barton, MD, says in a news release.

In 85% of these "discordant pairs," the doctors' assessments underscored the disease severity as compared to the patients' assessments, the researchers say.

But 30% of patients exhibited signs of major depression, and they are the ones whose disagreement with their doctors was greatest.

There was a lower level of disagreement in patients who had a higher swollen joint count, but disagreement persisted in people with poorer function.

"Reducing patient-doctor discordance is an important goal that can improve patient outcomes," Barton says. "Further investigation of the relationships between mood, disease activity, and discordance may help guide interventions that improve RA patient care."

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