Anne Winkler, MD: Importance of Patient-Reported Outcomes in Treating Lupus

In the final part of our 3-part feature on patient-reported outcome measures (PROMs) in rheumatology, we interviewed Anne Winkler, MD, to discuss the importance of PROMs when treating her patients with lupus and lupus nephritis. She explains how she utilizes the routine assessment of patient index data 3 (RAPID3) questionnaire to discover how her patients are feeling regarding depression and anxiety, which can impact pain and, in some instances, mirror symptoms of flare. Winkler is an independent rheumatologist who does outreach work to help provide specialty rheumatology care to more underserved areas. She is affiliated with Mercy Hospital in Carthage, Missouri.

Anne Winkler, MD: We rheumatologists like objective measures, perhaps in part because we don't have a lot of options in our field. It is important to pay attention to the patient and what they're feeling, and the patient-reported outcome is one of the easiest ways to capture that. I use a RAPID3 on almost all of my patients. Part of the reason I do that, even though it's not been validated for everything, although it has been in rheumatoid arthritis and psoriatic arthritis, is because it has 3 questions on it that have to do with depression and anxiety. In my experience, patients may not tell you about depression and anxiety. It also gives you a better sense of how they really think they're doing, because a lot of times patients don't want to disappoint the doctor. They’ll come in and tell you they’re doing fine, but when you look at the RAPID3 you find out that they can't even open a jar or that they’re clearly feeling depressed. We need to address that because no matter what else is going on, if they’re depressed, for whatever reason, if we don't address that, they’re not going to feel better.

It’s important to understand rheumatologists don't solely base their decision-making process on PROs. Occasionally, someone comes in experiencing pain that's not due to their or lupus or rheumatoid arthritis. The patient may think that, and sometimes it is, but other times it's not. Sometimes they're depressed and that's why they're not sleeping well. You have to recognize that. It's important to look at the whole picture. That's what we try to do in rheumatology. We’re looking at the labs, X-rays, patient history, and what the patient is saying, so that we can sit down and say, “This is what I think is causing your chest pain and this is what I think we need to do next. What are you thinking?”

I've always felt that we, as doctors, are the advisors and we should try to present the information in a way that's understandable. Ultimately, the patient should make the decision because it's their body, their lives, and their healthcare. It’s called patient shared decision making.

Rheumatology Network: I absolutely agree. It is so important to have patient-reported outcomes as a piece of the bigger puzzle of disease management. We recently published an article on the RAPID3 questionnaire that showed it can reduce outpatient visits in patients with rheumatoid arthritis. There’s definitely a need for that a value for it as well.