July 18, 2018
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More than one-third of patients disagree with physician on RA remission

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Approximately 36% of patients with early rheumatoid arthritis disagree with their physician regarding whether they are in remission, according to findings published in BMC Rheumatology.

“Since [RA] patients are at risk for joint damage due to inflammation, the treatment goal in these patients is to attain a state of absence of disease activity, or remission,” Samina A. Turk, MD, of the Amsterdam Rheumatology and Immunology Center, and colleagues wrote. “However, clinical response and remission are defined in multiple ways and measured with different instruments, resulting in substantial variation of the proportion of patients classified as being in remission. A particularly common difference is seen between the physician and the patients view on the RA disease activity.”

To determine the agreement between both patient- and physician-perceived remission and the various clinical definitions of response and remission, and to analyze the differences in clinical and patient-reported outcomes among those who did not agree with the physician, the researchers recruited 84 patients with early RA from the Amsterdam Rheumatology and Immunology Center. Participants were adults with no prior treatment with disease modifying antirheumatic drugs, who agreed to receive methotrexate with 5 mg of folic acid and glucocorticoids between June 2014 and December 2016.

After 12 weeks, Turk and colleagues determined DAS44, American College of Rheumatology (ACR)/EULAR Boolean-based remission, EULAR good and ACR70 responses for each patient. Patient-perceived remission was determined by asking each participant “Would you say that, at this moment, your disease activity is as good as gone?” Physician-perceived remission was based on a visual analogue score for global disease severity. Among patients who disagreed with the physician, those who perceived themselves to be in remission were compared to those who did not in terms of Rheumatoid Arthritis Impact of Disease (RAID).

According to the researchers, the overall agreement between physician-perceived and patient-perceived remission was 64% (P <.01). Remission as declared by a physician had a 79% agreement with the EULAR good measure, while patient-perceived remission had a 69% agreement with both EULAR good and the ACR70 response. In addition, patients who did not see themselves as in remission reported less improvement on RAID measures, particularly pain, sleep and emotional well-being.

“This might have consequences for patient satisfaction, the relationship between patient and physician and treatment compliance of the patient,” Turk and colleagues wrote. “Patients who disagreed with their physician on being in remission showed less improvement on questions about sleep, pain and emotional well-being of the RAID. However, not only patients and physicians showed discordance, there were also many differences between clinical response and remission definitions. This makes it necessary to increase patient involvement in their own health care decisions, improving shared decision making.” – by Jason Laday

Disclosure: Turk reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.