Treat‐to‐target in rheumatoid arthritis: Evaluating the patient perspective using the Patient Opinion Real‐Time Anonymous Liaison system: The RA T2T PORTAL study

Abstract

Objectives:To determine the level of agreement among patients with rheumatoid arthritis (RA) with the principles and recommendations of the treat-to-target (T2T) initiative in New Zealand (NZ) and to further explore specific patient opinions via online iterative surveys. Methods: Participants with RA were recruited from rheumatology clinics in NZ and invited to receive and reply to surveys administered via the Patient Opinion Real-Time Anonymous Liaison (PORTAL) system. An enrolment survey recorded demographics, disease duration and treatment and then RA T2T surveys were administered weekly. A Likert scale 1-5 measured agreement with the principles and recommendations and further surveys explored responses of interest identified by investigators from each prior survey.Results: One hundred and ninety patients consented to participate in PORTAL and 132 in the RA T2T surveys. Level of agreement with RA T2T principles was: 93.3% to 99.3% and to the recommendations: 77.3%-100%. The lowest level of agreement 77.3% was with recommendation 8, 3 monthly treatment adjustment, and the highest was 100% agreement with recommendation 10, shared decision-making. Patients agreed less with low disease activity as the target compared with remission (91.4% and 98%). Despite high-level agreement for the use of a disease activity score (95.7%), 23% did not feel the individual components reflected their disease control. Patients rated difficulty coping, erosions on imaging, health-related quality of life and pain all significantly higher than C-reactive protein as indicators of worsening arthritis. Conclusions:Despite a high level of patient agreement with RA T2T this study highlights the importance of patient engagement in the RA T2T process to individualize therapy adjustments, make shared decisions and decide on targets that accurately reflect disease control according to patients. K E Y W O R D Srheumatoid arthritis, shared decision making, treat-to-target | 875 BENHAM Et Al.

Remission Induced by TNF Inhibitors Plus Methotrexate is Associated With Changes in Peripheral Naïve B Cells in Patients With Rheumatoid Arthritis

“…Currently, the core principles of the treat-to-target (T2T) strategy in RA are shared decision-making and regular patient review with a target of REM or, failing that, low disease activity to ensure optimal outcomes (37,38). Therefore, objective parameters of REM are necessary to achieve a successful outcome following the T2T strategy.…”

A patient‐centered knowledge translation tool for treat‐to‐target strategy in rheumatoid arthritis: Patient and rheumatologist perspectives

“…17 Additionally in 2 further studies from Canada and New Zealand which sought patient perspectives on RA-T2T, both demonstrated high levels of agreement with the principles and recommendations. 21,22 Rheumatologists in this survey agreed highly with RA-T2T recommendations with the exception of the routine use of a validated composite disease activity score. Forty-nine percent of rheumatologists reported they always or very often used a disease activity score in daily practice to guide treatment decisions.…”

“…This is supported by a previous report indicating that a patient version of the original RA‐T2T principles and recommendations was endorsed with high levels of agreement by patients 17 . Additionally in 2 further studies from Canada and New Zealand which sought patient perspectives on RA‐T2T, both demonstrated high levels of agreement with the principles and recommendations 21,22 …”

Understanding Fatigue‐Related Disability in Rheumatoid Arthritis and Ankylosing Spondylitis: The Importance of Daily Correlates

“…Patients with rheumatoid arthritis (RA) included in this study were enrolled from a group of patients who had volunteered to offer ongoing opinions on their experience of living with RA via an online sampling project, The Patient Opinion Real‐Time Anonymous Liaison project (30). Patients with ankylosing spondylitis (AS) were recruited during 2018 by a research assistant through the Dunedin Hospital Rheumatology Outpatients Clinic and from a database of patients who participated in the Spondyloarthritis Genetics and the Environment study, a 5‐year longitudinal study looking at outcomes in spondyloarthritis.…”