Physician-Patient Collaboration Best Way to Evaluate Systemic Sclerosis?

Patients who have systemic sclerosis (SSc) and their physicians rate disease severity differently in magnitude and are influenced by different factors. Therefore, patient-assessed and physician-assessed measures of severity should be considered as complementary.

Hudson and associates compared physician and patient assessment of SSc severity in 803 patients from the Canadian Scleroderma Research Group Registry. Participants numerically rated the following parameters of disease severity: skin involvement, Raynaud phenomenon (RP), dyspnea, GI symptoms, number of fingertip ulcers, tender and swollen joints, and fatigue.

Patients and physicians agreed only modestly about disease severity; patients rated themselves as sicker. Interphysician variability accounted for only a small part of the differences in assessments. The relative importance of parameters also differed-physicians and patients rated skin involvement and pain, respectively, as more important severity indicators. Overall, patients were most influenced by subjective symptoms; significant predictors of patient assessments included severity of RP, GI symptoms, and fatigue. Physicians were affected by such objective measures as disease duration, with early disease being considered worse, and creatinine levels.

On the basis of their findings, the authors recommended collaboration between physicians and patients in the evaluation of SSc severity.