Shared Decision-Making Is Lacking For Patients With High RA Disease Activity

Patients with rheumatoid arthritis (RA) prioritize their physician’s treatment goals over their own, which may explain why many with high disease activity do not receive another treatment option, according to the findings of a recent study.

“Few studies have investigated patients’ own treatment goals in RA,” the researchers said. They sought to identify factors that patients believed influenced their physician’s treatment decisions by analyzing data of 249 participants with RA from the ArthritisPower. Participants included in the study had not changed treatment within the past 3 months and were either currently receiving or had previously received disease-modifying antirheumatic drugs.

In December 2017, each participant completed Patient-Reported Outcomes Measurement Information System-Computerized Adaptive Tests (PROMIS-CAT) for pain interference, fatigue, sleep disturbance, and physical function. They also completed an online survey on barriers to treatment optimization, including self-perception of disease compared with Routine Assessment of Patient Index Data 3 (RAPID3)/PROMIS scores.

Overall, 66% of participants did not change their treatment, which was based on their physician’s recommendation. __________________________________________________________________
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Based on RAPID3 scores, 70% of participants had high disease activity (median score 18). Of those with high RAPID3 disease activity, 38% were offered a treatment change, but 29% of those who were offered the change did not accept it.

Among the participants who chose to intensify treatment, 51% did so because their symptoms had remained severe or worsened, while 25% of participants opted to intensify their treatment because they had not reached a specified treatment goal.

In addition, 81% of the participants self-reported their disease activity as “none/low” or “medium.” However, 68% of these participants had high disease activity based on RAPID3 scores. Compared with RAPID3, most PROMIS scores showed moderate agreement with participants’ self-assessment of health status.

“Patients should be encouraged to share their treatment goals/expectations with their rheumatologist, in line with the treat-to-target approach,” the researchers concluded.

“RAPID3 may be inappropriate for setting patient-centric treatment goals given the poor agreement with self-reported disease activity; most PROMIS scores showed better alignment with patients’ own assessments,” they added.

—Colleen Murphy

Reference:

Gavigan K, Nowell WB, Serna MS, Stark JL, Yassine M, Curtis JR. Barriers to treatment optimization and achievement of patients’ goals: Perspectives from people living with rheumatoid arthritis enrolled in the ArthritisPower registry. Arthritis Res Ther. 2020;22(1):4. doi:10.1186/s13075-019-2076-7.