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Changes in priorities for improvement in patients with rheumatoid arthritis during 1 year of anti-tumour necrosis factor treatment

Peter M ten Klooster¹, Martine M Veehof¹, Erik Taal¹, Piet L C M van Riel², Mart A F J van de Laar^1,3

¹ Institute for Behavioral Research, University of Twente, Enschede, The Netherlands
² Department of Rheumatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
³ Department of Rheumatology, Medisch Spectrum Twente, Enschede, The Netherlands

Peter M ten Klooster, Institute for Behavioral Research, Faculty of Behavioral Sciences, University of Twente, PO Box 217, 7500 AE Enschede, The Netherlands; p.m.tenklooster{at}utwente.nl

Objectives: To examine priorities for health status improvement in patients with active rheumatoid arthritis (RA) during anti-tumour necrosis factor (TNF) treatment.

Methods: Data were used from 173 patients with RA starting treatment with TNF-blocking agents. Outcome measures included assessment of health status with the Arthritis Impact Measurement Scales 2 (AIMS2) at baseline and after 3 and 12 months. The AIMS2 contains a priority list from which patients are asked to select from 12 areas of health the 3 in which they would most like to see improvement.

Results: After 1 year of treatment, 10 out of 12 areas of health on the AIMS2 were significantly improved. The most commonly selected priorities for improvement at baseline were pain (88%), hand and finger function (57%), walking and bending (42%), mobility (33%), and work (29%). At group level, this priority ranking remained largely unchanged during treatment. After adjustment for multiple comparisons, only pain was selected significantly less often at 3 and 12 months (71% at both assessments). Within individual patients, however, priorities often changed. Changes in the priority of pain were related to the achieved level of patient-perceived pain and disease activity.

Conclusions: This study shows that, at the group level, patients’ priorities for improvement are fairly stable during 12 months of anti-TNF therapy, despite major improvements in health status. Although pain reduction becomes somewhat less important, it remains the most commonly selected priority. In contrast, individual patient priorities are not stable over the course of treatment and appear to be associated with differences in disease state.

Abbreviations: AIMS2, Arthritis Impact Measurement Scales; DAS, Disease Activity Score; DREAM, Dutch Rheumatoid Arthritis Anti-TNF Monitoring; HAQ-DI, Health Assessment Questionnaire Disability Index; RA, rheumatoid arthritis; RADAI, Rheumatoid Arthritis Disease Activity Index; TNF, tumour necrosis factor; VAS-GH, Visual Analogue Scale for General Health

Keywords: rheumatoid arthritis; health status; pain; patient priorities

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