better doctor-patient cooperation for optimized treatment

Spondylitis should no longer be ankylosing in 2018 and for this, it must be diagnosed faster and it must be treated more appropriately.

The only way to improve this management is through better patient education, a better understanding by doctors of patients' expectations and concerns, and a better understanding by patients of explanations and the reasoning of doctors.

A diagnosis too late

More than 7 out of 10 people will have back pain during their lifetime, most often by episodes but sometimes chronically. In the majority of cases, the cause is related to an alteration of the spine. But in about 5 to 10% of cases, the cause may be related to a chronic inflammatory disease: it is then a "spondylarthritis".

When a low back pain recurrence too frequently or lasts more than 3 months, especially in a person under 45, whether a man or a woman, it is appropriate to ask the only interesting question: "At what time the back makes it the worst: morning or evening? ".

If the answer to this question is: "in the morning", if this pain may be responsible for waking up in the 2nd part of the night or early morning ("waking-morning" pain), if it is accompanied by a stiffness of the back in the morning that lasts at least half an hour ("rustling morning") and then fades in the day. If this pain is relieved to at least 50% in less than 24 to 48 hours by a simple non-steroidal anti-inflammatory drug … the question of the existence of inflammatory lower back pain no longer arises and the diagnosis will be confirmed by the rest clinical examination and examinations.

Doctors who do not manage enough worries

In spondyloarthritis, physicians are primarily focused on establishing the diagnosis, eliminating differential diagnoses, badessing the prognosis and finally, defining a suitable therapeutic plan and monitoring. However, until quite recently, the very evaluation of the disease remained very empirical, or based on criteria that did not necessarily correspond to the patients' expectations.

A French study, the EPOC study, had shown that doctors are generally mistaken about patients 'worries and concentrate their explanations on treatments, while patients' fears are more about the disease and its evolution. Indeed, in this study, while these patients have been suffering from spondyloarthritis for more than a decade and they are doing well thanks to an adapted treatment, it turns out that they have very different fears concerning the disease and not just its treatment, as well as often erroneous beliefs.

Nearly two-thirds of the patients express, in fact, fears which concern especially the evolution of their disease (still suffering from the pain and a new inflammatory flare of the disease, having deformations of the joints …) and a possible invalidity. (losing the function of all the joints, losing his autonomy, being a burden for his family, not being able to have projects …). More serious, more than one in two patients is afraid of "ending up in a wheelchair" even though this risk is almost absent in these diseases.

The problem is that too much focus on treatment, doctors do not rebadure enough patients. They risk leaving them alone faced with erroneous beliefs and their anxieties, with probably the risk of poor treatment monitoring, even though it has now been shown that a well-adapted and well-followed treatment will put the majority inflammatory rheumatism in near remission.

Patients who do not understand doctors well

Most doctors, however, give explanations about the disease and the treatment, but because of the limited time of the consultation, these explanations are often a little dense, difficult to memorize, and delivered in a medical jargon that the patients struggle to understand. However, it is possible to improve the level of explanations, by limiting the number of information to each consultation, using simple terms that the patient must not hesitate to be explained if he does not understand them. It is also necessary for patients to consult medical information sites validated by their doctor and noting all the questions that come to their mind between the consultations in order to ask them during the consultation.

These are the questions that will allow the doctor to better understand the level of knowledge and understanding of the disease by the patient. The doctor can then better adapt his speech, better question the patients on these expectations and concerns. The patient should not, for fear of annoying the doctor, hesitate to talk to him about small pains or unusual signs. Each sign may have special meaning for the physician in the context of the disease. No retention of information, therefore. A fluid communication between the patient and the doctor is the only guarantee of a well-followed and well-adapted treatment, essential in this disabling chronic disease if it is badly treated.

In chronic diseases, the doctor-patient relationship must evolve: the patient must be well acquainted with his illness in order to possibly adjust his treatment, or even to anticipate the consultation in case of an unforeseen event. The patient must absolutely learn a new profession: to be a specialist in his illness and his treatment, exactly as in diabetes. The doctor must be the expert consultant, who will answer questions, keep the patient informed of the news and update a suitable therapeutic plan, all in an atmosphere of empathy.

The interview of Mr. Cedric Stadelmann (Association France Spondylarthritis)