Comparison of US patient, rheumatologist, and dermatologist perceptions of psoriatic disease symptoms: results from the DISCONNECT study

Abstract

BackgroundThe perceived bother of skin and joint-related manifestations of psoriatic disease may differ among patients, rheumatologists, and dermatologists. This study identified and compared the patient and dermatologist/rheumatologist-perceived bother of psoriatic disease manifestations.MethodsOnline surveys were administered to patients with both psoriasis and psoriatic arthritis and to dermatologists and rheumatologists. Object-case best–worst scaling was used to identify the most and least bothersome items from a set of five items in a series of questions. Each item set was drawn from 20 items describing psoriatic disease skin and joint symptoms and impacts on daily activities. Survey responses were analyzed using random-parameters logit models for each surveyed group, yielding a relative-bother weight (RBW) for each item compared with joint pain, soreness, or tenderness.ResultsSurveys were completed by 200 patients, 150 dermatologists, and 150 rheumatologists. Patients and physicians agreed that joint pain, soreness, and tenderness are among the most bothersome manifestations of psoriatic disease (RBW 1.00). For patients, painful, inflamed, or broken skin (RBW 1.03) was more bothersome, while both rheumatologists and dermatologists considered painful skin much less bothersome (RBW 0.17 and 0.22, respectively) than joint pain. Relative to joint pain, rheumatologists were more likely to perceive other joint symptoms as bothersome, while dermatologists were more likely to perceive other skin symptoms as bothersome.ConclusionsThis study has identified important areas of discordance both between patients and physicians and between rheumatologists and dermatologists about the relative bother of a comprehensive set of psoriatic disease symptoms and functional impacts. Both physician specialists should ask patients which manifestations of psoriatic disease are most bothersome to them, as these discussions may have important implications for drug and other patient management options.Electronic supplementary materialThe online version of this article (10.1186/s13075-018-1601-4) contains supplementary material, which is available to authorized users.

Relationship of pain and fatigue with health-related quality of life and work in patients with psoriatic arthritis on TNFi: results of a multi-national real-world study

“…A recent study comparing the perceptions of psoriatic disease symptoms in the USA revealed areas of discordance between both patients and physicians, and between rheumatologists and dermatologists, on a comprehensive set of disease symptoms and functional impacts. 39 In agreement with this and other studies, we also observed discordance between patient-reported symptoms and physician’s assessment of disease in our global patient sample. 39 – 41 …”

“… 39 In agreement with this and other studies, we also observed discordance between patient-reported symptoms and physician’s assessment of disease in our global patient sample. 39 – 41 …”

“…38 A recent study comparing the perceptions of psoriatic disease symptoms in the USA revealed areas of discordance between both patients and physicians, and between rheumatologists and dermatologists, on a comprehensive set of disease symptoms and functional impacts. 39 In agreement with this and other studies, we also observed discordance between patient-reported symptoms and physician's assessment of disease in our global patient sample. [39][40][41] A major strength of this study is that it presents realworld data in patients with PsA treated with TNFi around the world, and the negative impact on patient's HRQoL and WPAI associated with pain and/or fatigue despite advanced therapy.…”

“…39 In agreement with this and other studies, we also observed discordance between patient-reported symptoms and physician's assessment of disease in our global patient sample. [39][40][41] A major strength of this study is that it presents realworld data in patients with PsA treated with TNFi around the world, and the negative impact on patient's HRQoL and WPAI associated with pain and/or fatigue despite advanced therapy. However, several potential limitations associated with data derived from this study should be considered.…”

Disease Characteristics and the Burden of Joint and Skin Involvement Amongst People With Psoriatic Arthritis: A Population Survey

“…In the Disconnect study, an online survey was used to assess the perceived bother of joint and skin symptoms to PsA patients (n = 200). Using a best-worst scaling methodology, the investigators found the most bothersome symptom identified by the patients who completed the survey was painful, inflamed, or broken skin, followed by joint pain, soreness, or tenderness [27]. Patient surveys done during the development of the PsAID instrument also found that skin symptoms, in addition to pain and fatigue were the three most impactful symptoms identified by patients [24].…”