Study Suggests Patient–Provider Discordance in RA Needs to Be Addressed

Patients with rheumatoid arthritis (RA) and their rheumatology healthcare providers commonly face discordance as many patients report a higher disease activity rate than their providers.

A study published in Arthritis Research & Therapy examined the discordance between patients with RA and their healthcare providers by conducting an observational study of RA patients at the Mayo Clinic in Rochester, Minnesota. A total of 350 patients diagnosed with RA or inflammatory polyarthritis were identified by the research coordinator. These patients were seen for an appointment in the out-patient rheumatology practice within 4 weeks of screening. Additionally, electronic medical records were obtained to determine the eligible participants and to assess the disease activity, clinical characteristics, comorbidities, and medications.

“Many studies have sought to identify the determinants of patient-provider discordance in RA. Previous cross-sectional studies have reported that patient-reported measures of pain intensity, fatigue, depression, physical function, and health-related quality of life are key correlates of discordance,” the authors wrote. “…Therefore, this study aimed to delve deeper into the clinical correlates of patient-provider discordance by explicating the potential etiologic domains underlying the adverse health status of patients.”

The data suggested that patient-provider discordance affected 32.5% of the 350 consecutive patients. Of the population, 29.5% were found to have rater a higher disease activity than their providers, while only 3.1% rated a lower disease activity than their providers. Also, positive discordance was related to negative rheumatoid factors, anticyclic citrullinated peptide antibodies, lack joint erosions, depression, and the use of opioids, antidepressants, anxiolytics, or fibromyalgia medications. Overall, the rate of patient-provider discordance was determined to be at 33%, although a significant percentage of these patients rate their condition as more severe than their providers.

“The findings suggest that routine measurement of patient-reported outcomes could help identify the central drivers of adverse health status apart from inflammatory disease activity and thereby could suggest potential interventions,” the authors wrote.

These findings should promote the development of a standardized approach and assessment to evaluate and manage rheumatoid arthritis, but until this development, providers should moniter the impact of a patient’s health status and treat the common comorbidities like depression, the authors suggested.