“The introduction and increasingly standard use of biologic disease-modifying antirheumatic drugs, or bDMARDs, alongside other novel treatments for people living with rheumatoid arthritis (RA) has improved the expected long-term prognosis for patients. These medications are proven to improve disease symptoms and to reduce inflammation and joint damage caused by the autoimmune disease. However, given the variable nature of RA and since each patient responds differently to these complex medications, the American College of Rheumatology recommends a treat-to-target approach where the patient and rheumatologist set goals for treatment effectiveness and make adjustments over time,” said study author W. Benjamin Nowell, PhD, director, Patient-Centered Research, CreakyJoints and principal investigator of ArthritisPower, in an interview with DocWire News.
To gain insight into how RA patients feel about these treatments, the researchers conducted a cross-sectional, web-based survey from December 2017 through January 2018. RA patients aged ≥ 21 years with at least one failed disease-modifying antirheumatic drug (DMARD) who had been on their current DMARD(s) for at least six months were eligible to participate. Patients filled out a 50-question survey regarding treatment history, symptoms, and flares, and they responded to the Rheumatoid Arthritis Impact of Disease (RAID) questionnaire and the Treatment Satisfaction Questionnaire for Medication (TSQM). Treatment satisfaction was defined as a TSQM global satisfaction score ≥ 80.
Most Patients Are Not Happy with Current Treatment
Final analysis included responses from 258 patients, most of whom were dissatisfied with their current RA treatment.
“Despite the variety of available medications, including bDMARDs, the study found that 74% of respondents with RA (n=258) expressed dissatisfaction with their treatment. Even while on treatment, respondents reported experiencing bothersome symptoms such as fatigue (82%), pain (76%) and physical limitations (75%), which negatively impacted their quality of life,” said Dr. Nowell. “One of the primary goals with a treat-to-target strategy is to reduce inflammation and pain, yet this study found that despite active treatment most respondents with RA still had either moderate disease activity (37%) or high disease activity (33%). Few respondents reported achieving remission (16%) or low disease activity (13%) with their current treatment.”
While the numbers are disappointing, the outcome did not come as a surprise to Seth Ginsberg, president and co-founder of CreakyJoints.
“It can take months or years to cycle through different treatments to find one that works effectively,” he told DocWire News. “What’s most worrisome is that people are experiencing bothersome symptoms but not always seeking to try something new, under consultation with their doctor.”
Dr. Nowell believes that one reason for this may be the daunting thought of starting the medication process anew.
“It can be scary for patients to countenance changes to their medications, even when something isn’t working optimally to manage their disease,” he explained. “Future research is required to better understand what motivates patients and their physicians to initiate and follow through on a treatment change.”
Two keys to combat this concern are communication and patient empowerment, according to Mr. Ginsberg.
“This study makes it clear that there is an urgent need to help patients and rheumatologists communicate better and empower patients to ask for a treatment change if they aren’t getting relief from symptoms and pain,” he said.