Rheumatologists Should Not Underestimate the Burden of OA

VBCR - June 2016, Vol 5, No 3 - Osteoarthritis
Alice Goodman

London, United Kingdom—Rheumatologists are fully aware of the impact of rheumatoid arthritis (RA) on patients’ lives, but underestimate the severity and impact of osteoarthritis (OA), according to the researchers of a study that looked at physician and patient perceptions of global disease status in both conditions.

“Osteoarthritis is a common and debilitating disease. Patients with osteoarthritis have functional disability and the presence of osteoarthritis predicts mortality,” stated Isabel Castrejon, MD, PhD, Assistant Professor, Rush University Medical Center, Chicago, IL, and lead author of the study. “Our study suggests that we are not doing enough for patients with this disease and that we [underestimate] its severity and impact on their lives.”

“The discordance between physician and patient perception of disease severity that we identified is important because of the negative impact it can have on shared decisions concerning the best choice of therapy,” she added. “This in turn is likely to interfere with treatment compliance and future outcomes.”

RA is generally perceived as a more severe medical condition than OA, but recent evidence suggests that both diseases have similar burdens, the study authors note. Despite this, OA is still regarded as less severe.

The study was conducted in a routine rheumatology academic setting, where all patients completed a multidimensional health assessment questionnaire (RAPID3) for physical function, pain, and patient global assessment, scoring from 0 to 10 with 10 being the most severe. A fatigue checklist, self-report joint count assessment, and demographic data were also included. Physician global assessments of each patient were also performed, using the same scoring method.

Patients were then categorized as having the following: patient global assessments worse than physician global assessments, patient and physician assessments that were equal, or physician assessments that were worse than patient assessments.

The study included 216 patients with RA, and 243 patients with OA. Eighteen percent of patients with RA had discordant patient–physician assessments showing that patients rated their disease as more severe than physicians, compared with 34% of patients with OA. Patient and physician assessments were concordant for 67% of patients with RA, and 56% with OA. Physicians rated disease severity as worse than patients’ ratings in 15% and 10% of RA and OA cases, respectively (P <.001).

“We treat RA more aggressively than OA, and we treat-to-target,” explained Dr Castrejon.

In general, orthopedic surgeons are more likely to be empathetic to patients with OA than rheumatologists, because the surgeons see patients at more advanced stages (ie, when they need joint replacement), whereas rheumatologists treat patients from the beginning.

“It is likely orthopedists’ perceptions would be more likely to be concordant with patients’ perceptions,” she suggested.

Although rheumatologists have an array of medications for treatment of RA, there are no medications that target the disease process of OA. In the absence of effective therapy—other than pain control—rheumatologists can communicate with, and show empathy toward, their patients with OA, and encourage weight loss and active exercise that can help their patients, Dr Castrejon commented.

Gerd Burmester, MD, European League Against Rheumatism President and moderator of the press conference where this study was discussed, has been involved in a study of OA of the hand, a disease that, according to him, has been “completely neglected.”

“This presentation is important because it raises awareness of rheumatologists’ under rating the disease burden of OA for our patients,” Dr Burmester explained. “The rheumatologist has limited treatment options for hand OA. The secret of treating any OA is multidisciplinary team care, comprising physicians, acupuncturists, and physical therapy.”

He also noted the importance of identifying inflammatory destructive OA, and stated that, in such cases, use of cytokines might be helpful.

“We know that physical and occupational therapy work,” Dr Burmester elucidated. “If you take OA seriously and are [empathetic], you can help your patients.”


  1. Castrejon I, Chua J, Block JA, Pincus T. Physician and patient estimates of global status are more likely to be discordant in osteoarthritis than in rheumatoid arthritis. Presented at: 2016 European League Against Rheumatism Annual Congress; June 8-11, 2016; London, United Kingdom. Accessed June 10, 2016.
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Last modified: July 12, 2016
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