Background The treatment of rheumatoid arthritis (RA) is not always escalated despite persistent disease activity. The difference between rheumatologists’ and patients’ expectations and opinions about factors relevant to deciding about changing the treatment can explain why a more aggressive treatment is sometimes avoided or delayed.
Objectives The aim of our study was to determine which factors are important for rheumatologists and for their patients in deciding that the current treatment is not successful and should be changed.
Methods We provided 90 rheumatologists (62 women and 28 men) and 82 RA patients (68 women and 14 men) with a 9-item questionnaire. The factors associated with the treatment failure suggested in the questionnaire were: persistent joint pain, deterioration of functional ability, persistent swelling of the joints, morning stiffness lasting more than one hour, tiredness, high erythrocyte sedimentation rate (ESR), worsening of erosions, rheumatologist’s decision about current therapy (patients’ questionnaire), patient’s opinion about worsening of the disease (rheumatologists’ questionnaire) and difficulties in performing paid work. The respondents were encouraged to add other relevant factors and comments.
Each factor was scored from 0 (not important) to 5 (very important) according to Likert’s scale.
We compared the importance scores amongst rheumatologists and patients.
Results Patients’ mean age was 61.4 (±10.9) and mean disease duration was 10.4 (±8.2) years. Rheumatologists’ mean age was 49.7 (±11.7) years. The most important reasons for rheumatologists to decide about a more aggressive treatment were: number of swollen joints, worsening of erosions, high ESR, deterioration of functional ability and morning stiffness. For the patients, the most important were: their doctor’s decision, deterioration of functional ability, persistent pain, worsening of erosions, and tiredness. Statistically significant differences between rheumatologists and patients were found for opinions about: swelling of the joints, ESR, morning stiffness, worsening of erosions and attitude to paid work (p<0.01). The importance of joint pain, deterioration of functional ability and tiredness was similar in both groups. There were no significant differences in opinions between women and men amongst the patients. Female rheumatologists were more inclined to strongly consider patients’ opinion than male rheumatologists were. The most common additional item added by the patients was drug intolerance. The most common additional item added by rheumatologists was high disease activity score (DAS28).
Conclusions Different factors are important for patients and rheumatologists in assessing treatment failure. Insufficient communication between patients and doctors can result in a delay in introducing a proper treatment.
Disclosure of Interest None Declared
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