Background On the T2T statement, the primary target for RA treatment is a clinical remission. Under existing circumstances, however, the remission may not be optimal to be a shared goal between RA patients and healthcare professionals. Since the word “remission” (“Kankai” in Japanese) is not widespread well in Japan, the National Institute for Japanese Language has recommended healthcare professionals to restate the remission in plain and common words. Although it has stated in overarching principles of EULAR 2013 recommendations that decision-sharing by patient and rheumatologist is overwhelmingly important, there may be a gap in conception of remission.
Objectives In this study, we investigated to find a gap between patients' comprehension and the concept of T2T and to gain the insight into true demands and patients' perspective of treatment goal.
Methods The self-administered questionnaire was conducted on 1011 patients in Tsuchida clinic from Aug through Nov in 2013. Questionnaire comprised perception of remission (Yes/No), sense of remission (VAS) and bother and concern about RA treatment (multiple choice/multiple answers allowed). The clinical data of each patient were collected at the day ± 6 weeks that the questionnaire was completed.
Results Patients comprised mean age: 61.7 years, mean DAS28-ESR: 2.5 and proportion of biologics use: 47.3% (Table). The basic knowledge of remission was assessed by asking patients “have you heard of the word REMISSION?” (yes: 50.9%), “do you know the meaning of REMISSION” (yes: 44.4%), ”do you know how to measure your disease activity?” (yes: 56.2%) and “Are you aware of your medical condition?” (yes: 77.0%). A subjective sense of own remission measured with mean VAS became higher (44.8 to 55.6) when it was rephrased as disappearance of signs and symptoms instead of using the word remission. These results revealed that phraseology of remission made a significant impact on sensory perception. Interestingly, in patients who had achieved clinical remission (DAS28-ESR), mean VAS for sense of own remission was significantly higher (48.8, N=421 P<0.0001) than that in patients who had not (37.8, N=299), although that was still lower than half even in patients in clinical remission. In addition, patient desires for RA treatment were determined from the questionnaire. The amount of time (43.6%) and frequency (19.9%) of routine visit to clinic were identified as bothersome aspects rather than the frequency (9.6%) and pain (8.7%) of injection/intravenous, implying that patients demand to incorporate RA treatment into daily routine. The biggest concern on RA treatment was future/continuity of care (76.2%) followed by drug cost (45.2%) and impact on work (36.6%).
Conclusions These results indicate that medical terminology is not patient friendly and might not be acceptable for patients as a shared goal. Our data suggest that not only pursuing clinical remission but also reconsidering the treatment goal through eyes of patients and that of exploring forms of therapy are needed.
Disclosure of Interest None declared