Patient-physician discordance in assessments of global disease severity in rheumatoid arthritis
Open accessAbstract
Objective: To determine the degree of discordance between patient and physician assessment of disease severity in a multiethnic cohort of adults with rheumatoid arthritis (RA), to explore predictors of discordance, and to examine the impact of discordance on the Disease Activity Score in 28 joints (DAS28). Methods: Adults with RA (n = 223) and their rheumatologists completed a visual analog scale (VAS) for global disease severity independently. Patient demographics, the 9‐item Patient Health Questionnaire (PHQ‐9) depression scale score, the Health Assessment Questionnaire score, and the DAS28 were also collected. Logistic regression analyses were used to identify predictors of positive discordance, defined as a patient rating minus physician rating of >25 mm on a 100‐mm VAS (considered clinically relevant). DAS28 scores stratified by level of discordance were compared using a paired t ‐test. Results: Positive discordance was found in 30% of cases, with a mean ± SD difference of 46 ± 15. The strongest independent predictor of discordance was a 5‐point increase in PHQ‐9 score (adjusted odds ratio 1.61, 95% confidence interval 1.02–2.55). Higher swollen joint count and Cantonese/Mandarin language were associated with lower odds of discordance. DAS28 scores were most divergent among subjects with discordance. Conclusion: Nearly one‐third of RA patients differed from their physicians to a meaningful degree in assessment of global disease severity. Higher depressive symptoms were associated with discordance. Further investigation of the relationships between mood, disease activity, and discordance may guide interventions to improve care for adults with RA.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Psychosocial processes can be pre-existing vulnerability factors or can emerge in response to ongoing pain.
“In the first category, psychosocial processes either exist within an individual as pre-existing “vulnerability” factor [e.g., distress20–22, trauma23, 24] or emerge for the first time in response to the experience of ongoing pain [e.g., fear-avoidance behavior 25, self-efficacy26, 27].”
From Evaluating psychosocial contributions to chronic pain outcomes (2018) · cites this paper as [23]
Strong prospective links exist between early-life traumatic experiences and later development of chronic pain.
“There are strong prospective links between early-life traumatic experiences and the subsequent development of chronic pain 23, 24, 66–69.”
From Evaluating psychosocial contributions to chronic pain outcomes (2018) · cites this paper as [23]
Childhood physical, sexual, and psychological abuse are risk factors for adult chronic pain conditions including fibromyalgia, irritable bowel syndrome, chronic pelvic pain, and temporomandibular joint disorders.
“childhood physical, sexual, and psychological abuse have all been demonstrated as risk factors for the development of chronic pain conditions in adulthood including fibromyalgia, irritable bowel syndrome, chronic pelvic pain, and temporomandibular joint disorders23, 69, 70.”
From Evaluating psychosocial contributions to chronic pain outcomes (2018) · cites this paper as [23]
A recent meta-analysis reported that past traumas are associated with a two- to three-fold increase in development of chronic widespread pain.
“In a recent metaanalysis, the authors reported that the presence of past traumas is associated with a 2- to 3-fold increase in the development of chronic widespread pain23.”
From Evaluating psychosocial contributions to chronic pain outcomes (2018) · cites this paper as [23]
Childhood abuse was associated with a 97% increased risk of having a painful somatic syndrome such as fibromyalgia in adulthood.
“abuse in childhood conferred a 97% increase in risk for having a painful somatic syndrome such as fibromyalgia in adulthood 23.”
From Evaluating psychosocial contributions to chronic pain outcomes (2018) · cites this paper as [23]
In adult veterans, combat exposure and PTSD have the strongest statistical association with chronic pain.
“in adult veterans, combat exposure and post-traumatic stress disorder (PTSD) have been shown to have the strongest statistical association with chronic pain 23, 24.”
From Evaluating psychosocial contributions to chronic pain outcomes (2018) · cites this paper as [23]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
The PHQ-9: Validity of a brief depression severity measure
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.2001.016009606.x · Cited by 44,910 · see citing works
Arnett, F. C., Edworthy, S. M., Bloch, D. A., McShane, D. J., Fries, J. F., Cooper, N. S., Healey, L. A., Kaplan, S. R., Liang, M. H., Luthra, H. S., et al. (1988) · Arthritis & Rheumatism · doi:10.1002/art.1780310302 · Cited by 19,753 · see citing works
Revised Criteria for the Classification of Rheumatoid Arthritis
Arnett, F. C. (1990) · Orthopaedic Nursing · doi:10.1097/00006416-199003000-00011 · Cited by 7,736 · see citing works
Prevoo, M. L. L., Hof, M. A. V., Kuper, H. H., Leeuwen, M. A. V., van de Putte, L. B. A., & van Riel, P. L. C. M. (1995) · Arthritis & Rheumatism · doi:10.1002/art.1780380107 · Cited by 6,250 · see citing works
Norman, G. R., Sloan, J. A., & Wyrwich, K. W. (2003) · Medical Care · doi:10.1097/01.mlr.0000062554.74615.4c · Cited by 4,700 · see citing works
Felson, D. T., Anderson, J. J., Boers, M., Bombardier, C., Chernoff, M., Fried, B. J., Fürst, D. E., Goldsmith, C. H., Kieszak, S. M., Lightfoot, R. W., et al. (1993) · Arthritis & Rheumatism · doi:10.1002/art.1780360601 · Cited by 1,639 · see citing works
Saag, K. G., Teng, G. G., Patkar, N. M., Anuntiyo, J., Finney, C., Curtis, J. R., Paulus, H. E., Mudano, A. S., Pisu, M., Melton, M. E., et al. (2008) · Arthritis Care & Research · doi:10.1002/art.23721 · Cited by 1,452 · see citing works
Monitoring Depression Treatment Outcomes With the Patient Health Questionnaire-9
L??we, B., Un??tzer, J., Callahan, C. M., Perkins, A. J., & Kroenke, K. (2004) · Medical Care · doi:10.1097/00005650-200412000-00006 · Cited by 1,354 · see citing works
Cytokines and major depression
Schiepers, O. J. G., Wichers, M. C., & Maes, M. (2005) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2004.11.003 · Cited by 1,235 · see citing works
Bruce, B., & Fries, J. F. (2003) · PubMed · Cited by 753 · see citing works
Angst, F., Aeschlimann, A., & Stucki, G. (2001) · Arthritis & Rheumatism · doi:10.1002/1529-0131(200108)45:4 · Cited by 746 · see citing works
Why ethnic minority groups are under-represented in clinical trials: A review of the literature
Hussain-Gambles, M., Atkin, K., & Leese, B. (2004) · Health and Social Care in the Community · doi:10.1111/j.1365-2524.2004.00507.x · Cited by 447 · see citing works
Ngo‐Metzger, Q., Sorkin, D. H., Phillips, R. S., Greenfield, S., Massagli, M. P., Clarridge, B. R., & Kaplan, S. H. (2007) · Journal of General Internal Medicine · doi:10.1007/s11606-007-0340-z · Cited by 439 · see citing works
The effects of ethnicity and language on medical outcomes of patients with hypertension or diabetes.
Pérez-Stable, E., Nápoles-Springer, A., & Miramontes, J. (1997) · Medical Care · doi:10.1097/00005650-199712000-00005 · Cited by 308 · see citing works
Language barriers between nurses and asylum seekers: their impact on symptom reporting and referral
Bischoff, A., BOVIER, P. A., Isah, R., Gariazzo, F., Eytan, A., & Louis, L. (2003) · Social Science & Medicine · doi:10.1016/s0277-9536(02)00376-3 · Cited by 266 · see citing works
The Feasibility of Using the Spanish PHQ-9 to Screen for Depression in Primary Care in Honduras
Wulsin, L. R., Somoza, E. C., & Heck, J. E. (2002) · The Primary Care Companion For CNS Disorders · doi:10.4088/pcc.v04n0504 · Cited by 240 · see citing works
(1993) · PubMed · Cited by 239 · see citing works
Effect of language barriers on follow-up appointments after an emergency department visit
Sarver, J. H., & Baker, D. W. (2000) · Journal of General Internal Medicine · doi:10.1111/j.1525-1497.2000.06469.x · Cited by 221 · see citing works
Are some perinatal deaths in immigrant groups linked to suboptimal perinatal care services?
Essén, B., Bødker, B., Sjöberg, N. ‐., Langhoff‐Roos, J., Greisen, G. O., Gudmundsson, S., & Östergren, P. ‐. (2002) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.2002.01077.x · Cited by 195 · see citing works
Patients and clinicians have different perspectives on outcomes in arthritis.
Hewlett, S. A. (2003) · PubMed · Cited by 192 · see citing works
Lack of Congruence in the Ratings of Patients' Health Status by Patients and Their Physicians
Suarez-Almazor, M. E., Conner-Spady, B. L., Kendall, C., RUSSELL, A. S., & Skeith, K. J. (2001) · Medical Decision Making · doi:10.1177/0272989x0102100204 · Cited by 166 · see citing works
Representation of American Blacks in Clinical Trials of New Drugs
Svensson, C. K. (1989) · JAMA · doi:10.1001/jama.1989.03420020117041 · Cited by 154 · see citing works
Hider, S., Tanveer, W., Brownfield, A., Mattey, D. L., & Packham, J. (2009) · Rheumatology · doi:10.1093/rheumatology/kep170 · Cited by 126 · see citing works
Representation of South Asian people in randomised clinical trials: analysis of trials' data
Mason, S., Hussain-Gambles, M., Leese, B., et al. (2003) · BMJ · doi:10.1136/bmj.326.7401.1244 · Cited by 118 · see citing works
Uğuz, F., Akman, C., Küçüksaraç, S., & Tüfekçi, O. (2009) · Psychiatry and Clinical Neurosciences · doi:10.1111/j.1440-1819.2008.01905.x · Cited by 109 · see citing works
Neville, C., Clarke, A. E., Joseph, L., Bélisle, P., Ferland, D., & Fortin, P. R. (2000) · PubMed · Cited by 107 · see citing works
Alarcón, G. S., McGwin, G., Brooks, K., Roseman, J. M., Fessler, B. J., Sanchez, M. L., Bastian, H. M., Friedman, A., Baethge, B. A., Reveille, J. D., et al. (2002) · Arthritis Care & Research · doi:10.1002/art.10512 · Cited by 99 · see citing works
Concordance between clinician and patient assessment of physical and mental health status.
Ck, K., Gt, O., Regan-Smith, M. G., Em, O., La, B., Jb, B., Rf, H., Kl, K., & Morgan, G. J. (1992) · PubMed · Cited by 96 · see citing works
Yen, J. C., Abrahamowicz, M., Dobkin, P. L., et al. (2003) · PubMed · Cited by 86 · see citing works
Depression History, Stress, and Pain in Rheumatoid Arthritis Patients
Zautra, A., Parrish, B. P., Puymbroeck, C. M. V., Tennen, H. A., Davis, M. C., Reich, J. W., & Irwin, M. (2007) · Journal of Behavioral Medicine · doi:10.1007/s10865-007-9097-4 · Cited by 85 · see citing works
Nicolau, G., Yogui, M. M., Vallochi, T. L., Gianini, R. J., Laurindo, I. M. M., & Novaes, G. S. (2004) · PubMed · Cited by 81 · see citing works
Concordant and discrepant views of patients' physical functioning.
Berkanovic, E., Hurwicz, M., & Lachenbruch, P. (1995) · Arthritis care and research : the official journal of the Arthritis Health Professions Association · doi:10.1002/art.1790080207 · Cited by 77 · see citing works
Swenson, S. L., Rose, M., Vittinghoff, E., Stewart, A. L., & Schillinger, D. (2008) · Medical Care · doi:10.1097/mlr.0b013e31816080e9 · Cited by 53 · see citing works
Self-citationRisk factors of symptom underestimation by physicians
Zastrow, A., Faude, V., Seyboth, F., Niehoff, D., Herzog, W., & Löwe, B. (2008) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2007.11.010 · Cited by 47 · see citing works
Ward, M. M. (1994) · PubMed · Cited by 47 · see citing works
Schillinger, D., Machtinger, E. L., Wang, F. M., Palácios, J., Rodriguez, M., & Bindman, A. B. (2006) · Journal of Health Communication · doi:10.1080/10810730600934500 · Cited by 45 · see citing works
Self-citationBardwell, W. A., Nicassio, P. M., Weisman, M. H., Gevirtz, R., & Bazzo, D. E. J. (2002) · Lara D. Veeken · doi:10.1093/rheumatology/41.1.38 · Cited by 40 · see citing works
Chest pain: Communication of symptoms and history in a London emergency department
Farmer, S. A., ROTER, D. L., & Higginson, I. J. (2005) · Patient Education and Counseling · doi:10.1016/j.pec.2005.09.009 · Cited by 32 · see citing works
Gardam, M. A., Verma, G., Campbell, A., Wang, J., & Khan, K. Z. (2009) · Journal of Immigrant and Minority Health · doi:10.1007/s10903-008-9221-8 · Cited by 30 · see citing works
Effects of Acculturation on the Reporting of Depressive Symptoms Among Hispanic Pregnant Women
Nguyen, H., Clark, M. C., & Ruiz, R. J. (2007) · Nursing Research · doi:10.1097/01.nnr.0000270027.97983.96 · Cited by 27 · see citing works
Carter, J. D., Lodhi, A. B., Nagda, S. R., et al. (2007) · PubMed · Cited by 8 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
The role of psychosocial processes in the development and maintenance of chronic pain
Edwards, R. R., Dworkin, R. H., Sullivan, M. D., Turk, D. C., & Wasan, A. D. (2016) · The Journal of Pain · doi:10.1016/j.jpain.2016.01.001 · Cited by 954 · see citing works
Evaluating psychosocial contributions to chronic pain outcomes
Meints, S. M., & Edwards, R. R. (2018) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2018.01.017 · Cited by 719 · see citing works
Pain, catastrophizing, and depression in the rheumatic diseases
Edwards, R. R., Cahalan, C., Mensing, G., Smith, M., & Haythornthwaite, J. A. (2011) · Nature Reviews Rheumatology · doi:10.1038/nrrheum.2011.2 · Cited by 596 · see citing works
- Authors
- Barton, J. L., Imboden, J., Graf, J., Glidden, D., Yelin, E. H., & Schillinger, D.
- Affiliations
- University of California, San Francisco (US)
- Venue
- Arthritis Care & Research
- Publisher
- Wiley
- Published
- 2010-05-28
- Volume
- 62
- Issue
- 6
- Pages
- 857-864
- ISSN
- 0893-7524 (ISSN-L)
- 2151-464X
- 2151-4658
- PMC
- PMC2885009
- OpenAlex
- W2042576796
- Cited by
- 191
- References
- 41
- Citations by year
- 2026: 9 · 2025: 3 · 2024: 13 · 2023: 10 · 2022: 11 · 2021: 10 · 2020: 15 · 2019: 10 · 2018: 15 · 2017: 17 · 2016: 14 · 2015: 14 · 2014: 7 · 2013: 16 · 2012: 12
- FWCI
- 9.38
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Arthritis Care & Research (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (P60AR053308)
- National Center for Research Resources (UL1RR024131)
- Topics
- Health Sciences › Medicine › Rheumatology › Rheumatoid Arthritis Research and Therapies
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Keywords
- rheumatoid arthritis, patient-physician discordance, disease activity assessment, DAS28, depression, PHQ-9, visual analogue scale, swollen joint count, language
- MeSH terms
- Adult, Aged, Arthritis, Rheumatoid, Depression, Female, Humans, Male, Middle Aged, Pain Measurement, Physician-Patient Relations, Severity of Illness Index, Cohort Studies
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
