Background Despite being widely accepted by Brazilians Rheumatologists there are significant barriers to implementation of Treat to Target (T2T) recommendations.
Objectives to evaluate acceptance by RA patients of these recommendations as well as their knowledge of their disease and its treatment.
Methods Twelve rheumatologists from 11 reference hospitals distributed throught all regions of Brazil participated in this study. A structured questionnaire with 27 questions (17 “Yes, No, Maybe”) questions and 17 multiple choice) was developed based on the fundamentals of T2T recommendations and presented to randomly selected RA patients, subjects of this survey. Student’s T and chi square tests were used; p<0.05 considered significant.
Results 230 RA patients answered the questionnaire: 90.1% female, mean age(SD)=52(SD12)yrs, disease duration=11(8)yrs. Most patients were under traditional DMARDs treatment (96%) vs. 27.5% on biologicals (p<0.01). Public health system cared for 77% of the patients; 45% were at the grade IV of Graffar scale (p=0.001);. mean years of study=8(5.2)yrs.
The majority would like to share treatment decision with their doctors (95%) and to be aware of treatment goals (98% = highest concordance) and strategies (94%). Sixty-five percent of the patients search for more information on RA but 93% would like to obtain more information from the medical staff. In agreement with the patients need for more information, the concepts of disease activity and remission were not completely understood with no predominant answer to the respective multiple choice questions). Interestingly, fatigue was considered important either as manifestation of disease activity or as an important symptom by few (<4%) patients. The above answers suffered no influence of disease duration, instruction degree and use of public or private medical care. Most patients are not familiar with biological treatments (52%), particularly if attended by the public system (p=0.01).
Monthly visits until achieving remission status were well accepted (86%), -less by private patients -66.7% - and justified by better control of disease activity; joint counting examination was considered relevant (90%) at each visit (71%).
Conclusions RA patients are eager to know more about their disease, treatment options and goals as well as to share treatment decisions. Specific barriers to T2T, such as too frequent visits, were not identified. Meaningful differences related to disease duration, study years or public vs. private medical care were not observed. Unfortunately, many patients are still unaware of medications and treatment strategies; educational programs and effective communications between doctors and patients are a serious unmet need in Brazil.
Boulos Haraoui et al. Treating Rheumatoid Arthritis to Target:multinational recommendations assessment questionnaire. Ann Rheum Dis 2011, 70:891.
Disclosure of Interest None Declared
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