Perceptions in 7700 patients with rheumatoid arthritis compared to their families and physicians

Objective: To compare perceptions of patients with rheumatoid arthritis (RA) to those of their families and usual physicians regarding pain and subjective experience of the disease. Methods: Questionnaires were mailed to patients listed in the files of a non-profit patient organization (Association Francaise des Polyarthritiques). Each patient, one family member (or close friend), and the usual physician were each asked to complete a questionnaire. Concordance among replies made by patients, family/friends, and physicians was evaluated using the kappa coefficient. Results: Questionnaires were sent to 20,468 patients, among whom 7702 (38%) mailed back adequate data. The family member was usually the spouse (70%) and the usual physician a rheumatologist (68%). Joint pain was described by patients as variable (80%) and unpredictable (68%). Patients reported a need to push themselves (86%), frustration (86%), anxiety about possible disease progression (89%), and being prevented from making plans for the future (6%). A negative impact was reported on recreational activities (84%), work (56%), and family life and sexuality (51%). Concordance was excellent for pain severity (kappa > 0.90) and good for the main joint-pain characteristics and experience of the disease (kappa > 0.70), although family members tended to overestimate, and physicians to underestimate, the intensity of the pain. Conclusion: We found good overall agreement between perceptions of patients, their families, and their physicians, despite differences between these last two groups. Our qualitative analysis showed not only a major physical impact of the disease, but also marked negative psychosocial effects. (C) 2007 Elsevier Masson SAS. All rights reserved.