Polish Rheumatologists and Rheumatoid Arthritis Patients Differ in Their Opinions About Treatment Inefficacy

Abstract

Objectives: This study aims to detect the differences of opinion between rheumatoid arthritis patients and rheumatologists concerning factors affecting escalation of disease modifying antirheumatic drugs (DMARDs). Materials and methods:The study included 82 rheumatoid arthritis patients (14 males, 68 females; mean age 61.4±11 years; range 35 to 84 years) and 85 rheumatologists (26 males, 59 females; mean age 49.7±11.7 years; range 33 to 77 years). All participants were asked to complete a survey which was composed of nine factors related to the ineffectiveness of RA treatment and the necessity of treatment change or DMARDs escalation. The patients were also asked to assess their satisfaction with current treatment and trust in their doctor. We collected demographic data of patients as well as their Disease Activity Score 28, erythrocyte sedimentation rate, and Health Assessment Questionnaire score. Results: Of the patients, 83% declared confidence in their doctor and 74.5% declared satisfaction with current therapy, while only 44% achieved low disease activity. The most important reasons for patients to escalate their therapy were persistent pain, functional impairment, progression of erosions, and rheumatologist's decision. For rheumatologists, the most important issues were progression of erosions, joints' swelling, high erythrocyte sedimentation rate, and morning stiffness. Radiological progression, joints' swelling, and high erythrocyte sedimentation rate were considered more important for DMARD escalation by physicians than by patients. Middle-aged rheumatologists of 41-60 years of age and female rheumatologists were more inclined to consider patients' opinion as a factor for treatment change. Conclusion: Different factors are important for rheumatologists and rheumatoid arthritis patients regarding DMARDs escalation. Treatment satisfaction is determined not only by disease activity indices but also by other patient-oriented factors. Improved communication between patients and physicians plays a significant role in achieving the therapeutic goal of tight control of the disease.

Assessment of discordance of treatment satisfaction between patients with rheumatoid arthritis in low disease activity or in remission and their treating physicians: A cross-sectional survey

“…To our knowledge, this is the first study to assess treatment satisfaction and alignment between paired patients with RA and LDA or remission and their treating physicians. Findings from previous studies of patients with RA that included patients with inadequate disease control or moderate to high disease activity levels have shown high levels of satisfaction with current RA treatment or communication with physicians [3,15], and high levels of satisfaction despite patients reporting moderate to severe impact of RA on their quality of life (QOL) [26]. Together with the current study, these findings suggest that patients with RA, irrespective of the severity and impact of their disease, come to accept living with varying degrees of symptoms and impaired QOL and are most likely to respond positively to questionnaires on treatment satisfaction.…”

“…Despite the importance of patient-reported outcomes (PROs), these outcomes may not be sufficiently utilized or prioritized in routine clinical practice [2]. Several studies in patients with immune-mediated diseases, including RA, show discordance between patients and physicians in their opinions about treatment inefficacy or treatment escalation [3], treatment targets and expectations [4], treatment satisfaction [5], and global assessment of disease [6]. For RA, the rate of discordance in global assessment of disease between patients and physicians varies with disease severity, treatments received, and how discordance is defined; however, disease status is generally rated worse by patients than by their physicians [7][8][9][10][11][12].…”

“…A recent systematic literature review [13] and analysis of phase 3 studies [14] indicated that a proportion of patients who achieve LDA or remission still have residual symptoms such as pain and fatigue, suggesting a potential gap in satisfaction between patients and their treating physicians. Several studies have compared patient and/or physician satisfaction with RA treatment [3,15,16]; however, they included patients with varying disease severity and did not assess concordance or discordance in treatment satisfaction between patients and physicians.…”