A recent article in the Journal of Arthritis and Rheumatism describes differences in perception patients with rheumatoid arthritis have regarding their disease activity and change in disease activity status compared to physician perception of these same variables. This has been described in the literature before. While this is an interesting issue in rheumatoid arthritis, it also applies to other musculoskeletal conditions as well.
In the setting of rheumatoid arthritis, the authors of this study conclude that patients and physicians need to share decision making and management of the condition. While this makes sense, there are a number of other issues that can be discussed as well. For starters, if a physician is only using labs and physical exam to make a decision about disease activity status, and ignoring imaging studies such as ultrasound or MRI, then there is certainly the potential for a gap in understanding. Utilizing readily available modalities such as musculoskeletal ultrasound is necessary for a rheumatologist to better understand how their patients are doing. Secondly, patients with rheumatoid arthritis are more likely to develop osteoarthritis, carpal tunnel syndrome, and tendinitis. Some of these issues may be secondarily related to active rheumatoid arthritis, some of these are unrelated as well. If one of my RA patients is not doing well, I will always consider whether there may be a different process at work that has not been adequately treated.
The same potential discrepancy in disease activity status should be considered in other musculoskeletal conditions as well. It is not uncommon for a person with knee osteoarthritis to have received treatment but still have some problems with their knee. Again the physician has to ask if there is more than just wear and tear arthritis at work. There are a number of other supporting structures that may need to be treated as well. Or perhaps a region outside of the knee is also contributing to that individuals pain, dysfunction, and overall declining quality of life.
Utilizing the latest in technology, old-fashioned listening and examination skills, and keeping an open mind will always be the key characteristics in a physician successfully assisting their patients.