Objectives Remission is the goal in treating RA patients. In a chronic disease like rheumatoid arthritis (RA), the patient's perspective may differ from the opinion of the treating physician. We ask our patients to rate their satisfaction with disease activity as such on a numerical scale from 1 “excellent” to 5 “failed” (PATSAT). In 3130 consecutive assessments, 529 in 247 pats fulfilled remission criteria according to DAS28 as well as to RADAI-5, a patient related outcome. 63% indicated PATSAT “excellent”, 35% “good” and 2% worse than that. It was of interest to investigate, why one third of these patients rated in a different way, as expected.
Methods Remission was defined as a DAS28-ESR ≤2.6 and a RADAI-5 ≤1.4 to obtain a clinical as well as a patient related outcome defining disease activity. 44 consecutive RA patients in remission classifying their PATSAT as 1 or 2 where asked for their reason to rate this way. Patients' clinical aspects were related to PATSAT 1 and 2. We had a closer look at the last two assessments of these patients to obtain information if disease course influences the decision. Moreover, three clinical psychologists categorized the obtained answers based on anxiety and/or depression. We present the differences in the two groups.
Results Twelve patients rated PATSAT 1 and 32 PATSAT 2. Patients did not differ in age, gender, disease duration or RA-therapy. We observed two different types of answers: First, patients with PATSAT 1 do not mention any clinical aspects of RA except pain, whereas this is the case in 91.3% of the patients with PATSAT 2. Moreover, pain seems to be important for scoring different: If pain is part of the answers of patients with PATSAT 1 (in 25%), there is definitely no pain at all, whereas in one third of the answers of patients with PATSAT 2 pain is the cause to rate this way. There also seems to be a more anxious and depressive attitude to the disease course when ranking PATSAT 2 and not PATSAT 1. Patients with PATSAT 1 had a lower CDAI, SDAI, RADAI-5, HAQ-DI, VASpain and VASGH than patients with PATSAT 2. More patients with PATSAT 1 were in Boolean Remission. Disease course in the past shows more disease activity and higher HAQs in patients with PATSAT 2 than with PATSAT 1.
Conclusions Pain and a higher level of anxiety/fear of worsening as well as a more unfortunate disease course may be the main reasons for patients to classify remission in RA as a state of “good” but not “excellent”.
Disclosure of Interest None declared