Background/Purpose: Rheumatoid arthritis and fibromyalgia are common diagnoses encountered in rheumatology practice. While rheumatoid arthritis is perceived as a valid medical condition and patients receive appropriate consideration and treatment, patients with fibromyalgia do not always get the same recognition for their painful condition. The aim of this study was to examine the physician’s illness perceptions of these two rheumatologic disorders, and evaluate how they correlate with their frustration or resistance to admit such patients. We also aimed to check if factors such as physician’s empathy and burnout influence illness perceptions and doctor- patient relationship.

Methods: Fifty-two rheumatologists attending one of the two rheumatologic national conferences during the study period were enrolled in the study. Demographic data was registered. Measures collected included the Brief Illness Perception Questionnaire (BIPQ) and the Difficult Doctor- Patient Relation Questionnaire (DDPRQ-10). Both of them were recorded twice, addressing fibromyalgia (FM) and rheumatoid arthritis (RA). Empathy and burnout were assessed by the Jefferson scale of physician empathy (JSPE) and the Shirom–Melamed Vigor Measure (SMVM)/ Shirom-Melamed Burnout Measure (SMBM).

Results: Of 52 physicians included in the study (58% men, mean age 50, mean years of practice 15), 56% were willing to accept fibromyalgia patients whereas 98% will accept rheumatoid arthritis patients. Fibromyalgia was considered a more severe disease than rheumatoid arthritis (FM- BIPQ mean score 58.6, SD 5.5 versus RA-BIPQ mean 49.7 SD 6.5, p< 0.00) especially in terms of consequences (beliefs about illness impact on physical, psychological and social functioning), treatment control (belief in cure through treatment), understanding and emotional response generated by the disease. Doctor-patient relationship was perceived more difficult with fibromyalgia patients compared to RA patients (FM-DDPRQ mean score 36.9, SD9.2 versus RA-DDPRQ mean 16.6, SD 7.1, p< 0.00). Difficult doctor-patient relationship with FM patients was significantly correlated to the lack of personal patient control over the disease (p=0.03), the impact of patient’s emotional response (p=0.01), and the burden of symptoms perceived as related to fibromyalgia (p=0.021). Resistance to accept FM patients was not correlated with illness perception but significantly correlated with higher scores of DDPRQ (p=0.024), especially with feeling discomfort towards and during a meeting with a patient with fibromyalgia. No correlation was found between empathy, burnout, years of practice and illness perceptions or willingness to accept fibromyalgia patients.

Conclusion: Fibromyalgia patients were perceived as more difficult than RA patients, with a large burden of symptoms and emotional response and a lack of control on their disease. A high proportion of physicians were reluctant to accept them because they feel emotional/psychological difficulties meeting and coping with these patients. Improving illness understanding and providing coping skills to rheumatologists may improve doctors-patients relationships and outcomes.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/good-pain-bad-pain-illness-perception-and-physicians-attitude-towards-rheumatoid-arthritis-and-fibromyalgia-patients/