Disease Perceptions and Treatment Goals Among RA Patients

A new study evaluated what factors patients with rheumatoid arthritis (RA) think affect their provider’s treatment decisions.

“Over the last decade, treatment for rheumatoid arthritis (RA) has improved dramatically, in part due to the treat-to-target (T2T) approach recommended by the American College of Rheumatology. Rheumatologists are encouraged to involve their patients in setting treatment targets (e.g., remission, or at least low disease activity [LDA]) as part of the T2T approach,” the researchers wrote. They further explained, “Patient reluctance to adjust their treatment has been reported as a barrier to meeting T2T in the U.S.A. Corrona and TRACTION behavioral intervention trials (52% of patients and 37% of visits, respectively). The patients’ perspective has become an increasingly important outcome assessment in RA. Emphasis is placed on understanding patients’ self-perception of disease improvement and disease-related limitations.”

The study was published in Arthritis Research & Therapy and included patients aged 19 years and older who were enrolled in the ArthritisPower registry. Patients were eligible for inclusion if they had physician-diagnosed RA, unchanged treatment during the three months prior to baseline, prior/current disease-modifying antirheumatic drug (DMARD) treatment, and access to a computer or smartphone. Patients filled out the Patient-Reported Outcomes Measurement Information System-Computerized Adaptive Tests (PROMIS-CAT) for pain interference, fatigue, sleep disturbance, and physical function. Disease activity scores, ranked from zero to 30, were determined by the Routine Assessment of Patient Index Data 3 (RAPID3). All patients responded to an online questionnaire to assess barriers to treatment optimization, which included their own perception of their disease versus their RAPID3/PROMIS scores.

Perceiving Rheumatoid Arthritis: Are Patients Accurate?

Final analysis included completed surveys from 249 patients (mean age [SD], 52 [11] years; 92% were female). High RAPID3 disease activity was observed in most patients (n = 175/249 [70%]; median score, 18). When asked why they did not change their treatment, most patients attributed this to their physician’s recommendation (n = 32, 66%). Among high RAPID3 disease patients, 66 (38%) received an offer to change treatment, of whom 19 (29%) rejected the change. Among patients who chose to intensify their treatment, most did so due to nonchanging or more severe disease symptoms (n = 65, 51%), while 16 (25%) said they were still looking to achieve a specific treatment goal. Overall, 202 patients (81%) stated their disease activity was none/low or medium; however, the majority of these patients still had high RAPID3 disease activity (137/202 [68%]; score > 12). Unlike RAPID3, PROMIS scores tended to agree with patient-reported health status.

The authors concluded, “Most participants trusted their rheumatologist’s treatment decisions and prioritized their physician’s treatment goals over their own. Patients should be encouraged to share their treatment goals/expectations with their rheumatologist, in line with the treat-to-target approach. RAPID3 may be inappropriate for setting patient-centric treatment goals given the poor agreement with self-reported disease activity; most PROMIS scores showed better alignment with patients’ own assessments.”