Objectives 1. To compare the patient perspective on remission in RA in comparison to the rheumatologist perceived remission perspectives.
2. To determine the value of Patient Reported outcomes in identifying specific symptoms and aspects of disease able to define remission in RA from the patient perspective.
Methods RA patients diagnosed according to ACR/EULAR criteria were treated according to treat-to-target regime with regular disease activity monitoring (every 1–3months). Remission was measured in two ways: 1) patient perceived remission using the question “Would you say that, at this moment, your disease activity is as good as gone? (yes/no)”; and 2) Physician perceived remission was defined as a physician global assessment ≤1 on a 0–10 VAS, phrased: “How active do you think the rheumatoid arthritis of your patient is today?” The study included 188 RA patients (76 males, 112 females; mean age 52.4±11 years) and 87 rheumatologists (30 males, 57 females; mean age 48.7±11.7 years). All participants were asked to complete a questionnaire which was composed of all domains identified in relation to the disease remission. 10 cm visual analogue scale (scored 0–10) was used to illustrate the importance of each factor in an individual opinion. The list included joint pain, functional ability, quality of life, absence of morning stiffness, absence of fatigue, normal laboratory tests, no comorbidity risk, radiologic remission, Disease Activity score and ability to work. In addition, patients were asked to complete a copy of the PROMs . One-way analysis of variance was used for the comparison of independent variables. Spearman correlation coefficient was used to assess the correlation between variables.
Results There were no significant differences in questionnaire answers in relation to patients' demographics and present disease activity. Regarding the patient perceived remission, the top 4 were: pain (76%), functional ability (71%), quality of life (69%) and fatigue (43%). Regarding the physician perceived remission, the following factors were rated more relevant by rheumatologists than the patients (p<0.001): low disease activity score (88%), radiologic remission and progression of erosions (76%), lab measures (ESR/CRP) (57%) followed by difficulties in performing paid work (49%).
Functional ability was scored significantly higher in patients >65 as compared with patients <65 years of age (9.6 vs 8.1 on VAS, p=0.03). In contrast the patient's cohort <65 years of age, rated quality of life at a higher level (9.7) than those below 65 (8.4). Functional ability was scored higher in patients with longer-standing disease as compared to patients with shorter disease duration (p<0.05). PROMs enabled the patient and the treating physician identify the aspects of relevance necessary for optimal clinical management.
Conclusions Different factors are important for rheumatologists and RA patients regarding disease remission. Treatment satisfaction is determined not only by disease activity indices but also by other patient-oriented factors. PROMs could optimise targeted therapy as it can play a significant role in identifying disease activity parameters relevant to both the treating rheumatologist as well as the patient.
El Miedany et al. Clin Exp Rheumatol 2010; 28(5):734–44.
Disclosure of Interest None declared