My Disease Is Worse Than Yours, Or Is It?
So often, we - people living with painful chronic conditions - can’t help ourselves but to compare our health-related situations with those of other conditions. It is human nature to try to determine, consciously or subconsciously, where we fit within a spectrum of possible life circumstances.
In other words, we may think to ourselves - MY (condition, situation, symptoms, disabilities, circle of friends, family members, job, etc) is/are more/less (painful, debilitating, impactful, hopeless, helpful, supportive, caring, loving, rewarding, etc) than YOURS.
In a newly published study appearing in PLoS ONE, an open-access journal of the Public Library of Science, researchers set out to compare disease burden in rheumatoid arthritis (RA), psoriatic arthritis (PsA), and axial spondyloarthritis (ax-SpA), three of the most common inflammatory rheumatic diseases. They compared patient-reported outcomes and composite scores of disease activity, as well as demographics and the use of disease-modifying anti-rheumatic drugs (DMARDs) and steroids.
Subjects of the study included patients who attended a single outpatient clinic in Norway in 2013 diagnosed with RA (n=1093; 68.5% female), PsA (n=365; 66.7% male), and ax-SpA (n=333; 49.3% female). The ax-SpA patients (48±12.9 years) were significantly younger than the PsA (55±12.4 yrs) and the RA patients (63±13.8 yrs), while the PsA patients had significantly shorter disease duration (9.9±8.2 yrs) than the RA (12.4±10.6 yrs) and ax-SpA (13.0±11.8 yrs) groups.
What researchers found:
- Reported pain, joint pain, fatigue, and patient assessment scores were similar in the PsA and ax-SpA groups, but significantly lower in the RA group after adjusting for age and gender. Differences in patient-reported outcome measures (PROMs) remained significant when adjusted for current DMARD use, steroids, and disease duration.
- Ax-SpA patients reported significantly more spine pain and spine pain at night than the RA and PsA groups. There was no significant difference in morning stiffness, SED rate, C-reactive protein, or MHAQ (modified health assessment questionnaire) scores between the groups.
- Patient global assessment tools such as the RAPID3 (Rapid Assessment of Patient Index Data 3) test correlated with physician assessment tools of disease activity, such as the DAS28-ESR, CDAI, BASDAI, and BASFI. However no significant difference was found for the physician global assessments between these three groups of patients.
- Composite disease activity measures were lower in the RA group than in PsA and ax-SpA groups, but the differences were small and probably not clinically significant, said authors. Lower patient-reported outcomes in the RA group may explain the difference.
- Among patients of working age, significant differences in employment status were found with only 26%, 32%, and 44.3% of the RA, PsA, and ax-SpA patients, respectively, employed full time. A higher percentage of the RA group (38.7%) were disabled pensioners compared to PsA (28.7%) and ax-SpA (17.3%) groups, and the general population (9.4%) of Norway in 2013. This is interesting in light of the lower pain and fatigue reported by RA patients.
- Higher proportion of ax-SpA patients (45.3%) were currently using biologics compared to RA (34.5%) and PsA (33.4%) patients. However, the use of traditional DMARDs is controversial in ax-SpA which may help to explain the group’s lower percentage. RA patients used significantly more steroids than the PsA and ax-SpA groups.
Authors suggest that their analyses indicate that disease burden in RA, PsA and ax-SpA may be more similar than demonstrated in previous studies.
What do you make of the above findings?
The first thing that really jumps out to me is that this group of RA patients reported better health outcomes than the PsA and ax-SpA patients, but as a group they are also older and more likely to be unemployed and on disability. One thing this study highlights is the importance of reducing pain in patients with inflammatory diseases to help improve their quality of life.
It’s not an issue of whose disease is worse, but perhaps who would benefit from better symptom control especially in regards to pain and fatigue.
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