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Depressed RA Patients Disagree With Doctors

Doctor-Patient Disagreements Can Affect Treatment and Outcome of Rheumatoid Arthritis
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."

The researchers write that "with the advent of increasingly effective yet potentially toxic therapies, the need for patient-provider agreement" about disease severity "is critical to the safe and effective management" of patients with rheumatoid arthritis.

Assessments of many diseases, such as diabetes and hypertension, can be made based on objective numerical measures, but rheumatoid arthritis lacks a "gold standard" that would inform both diagnosis and treatment, the researchers say.

The researchers write that previous research has shown that outcomes improve when rheumatologists and patients are on the same page.

Depression also has been previously associated with more pain and worse functionality of patients, the researchers write. They also note that disagreements might be influenced by doctor-patient communication.

It is also possible that depression interferes with the efficacy of therapy for RA and blunts response to treatment.

The researchers say more study is needed to explain the finding that disagreement between doctors and patients with depression is significant. An answer would be likely to improve treatment of patients with rheumatoid arthritis, the researchers say.

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