Background Despite improvements in the attainable clinical and health outcomes for patients with rheumatoid arthritis (RA), the goals of remission or low disease activity still remain difficult to achieve in a substantial proportion of patients. While rheumatologists have focussed on attainment of these goals, for many patients, particularly those who do not achieve these targets, additional treatment goals are control over pain and fatigue, as well as maintaining physical function and quality of life (QoL).
Objectives To examine patients' treatment aspirations and to identify the unmet needs for patients with RA receiving ongoing treatment and the associated humanistic and economic burden.
Methods Searches were performed using MEDLINE, Embase, PsycINFO and Econlit literature databases for articles published from 2004–2014 in the English language. Published literature was screened to identify articles reporting the burden of RA in patients receiving ongoing treatment. Core search terms included those related to the condition of study and treatment, and were combined with search terms related to humanistic and economic burden.
Results A total of 3212 articles were identified. After removing conference abstracts and duplicates and screening titles and abstracts, 77 publications that reported on the humanistic (68 articles) and economic burden (9 articles) of RA were selected for full text review. Despite clinically meaningful improvements in pain with the introduction of effective treatment algorithms, patient scores remained below the acceptable threshold in those receiving biologic therapy (1), whereas patients with RA receiving ongoing treatment with conventional disease-modifying antirheumatic drugs continued to experience moderate pain (2). Other health outcomes such as physical disability persisted above the threshold that patients would consider acceptable (3, 4) and mental health needs were also insufficiently met in a large proportion of patients with RA receiving ongoing treatment (5). In Europe, the health burden of RA was associated with an economic burden of € 45.3 billion, affecting patients, their families and society (6).
Conclusions Despite ongoing advances in the treatment of RA, many patients receiving currently available therapies continue to experience substantial disability and suboptimal QoL. RA is a multifaceted disease that can impact on individual patients in a variety of ways, some objectively evident and others known only to the patient themselves. Although a broad range of available pharmaco-therapeutic and management options are currently available, novel treatments and approaches are needed to address the associated unmet needs.
Fleischmann R. Open Access Rheumatology Research and Reviews. 2009;1:95–106.
Gronning K, Rodevand E, Steinsbekk A. Clin Rheumatol. 2010;29:1317–1322.
Westhovens R, Cole JC, Li T, et al. Rheumatology (Oxford). 2006;45:1238–1246.
Wells GA, Tugwell P, Kraag GR, Baker PRA, Groh J, Redelmeier DA. The Journal of Rheumatology. 1993;20:557–560.
Strand V, Singh JA. Drugs. 2010;70:121–145.
Lundkvist J, Kastang F, Kobelt G. Eur J Health Econ. 2008;Suppl 2:S49–60.
Acknowledgements Medical writing support was provided by Neel Misra of Engage Scientific Solutions and was funded by Pfizer Inc.
Disclosure of Interest P. Taylor Consultant for: Pfizer, A. Moore: None declared, R. Vasilescu Shareholder of: Pfizer, Employee of: Pfizer, J. Alvir Shareholder of: Pfizer, Employee of: Pfizer, M. Tarallo Shareholder of: Pfizer, Employee of: Pfizer