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Standardizing and personalizing the treat to target (T2T) approach for rheumatoid arthritis using the Patient-Reported Outcomes Measurement Information System (PROMIS): baseline findings on patient-centered treatment priorities

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Bacalao EJ1, Greene GJ2, Beaumont JL2, Eisenstein A2,3, Muftic A2, Mandelin AM1, Cella D2, Ruderman EM4. Clin Rheumatol. 2017 Aug;36(8):1729-1736. doi: 10.1007/s10067-017-3731-5. Epub 2017 Jun 26.

Abstract

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1 Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine, NMH/Galter Room 14-100, 675 N. St. Clair, Chicago, IL, 60611, USA.

2 Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

3 CJE SeniorLife, Leonard Schanfield Research Institute, Chicago, IL, USA.

4 Department of Medicine, Division of Rheumatology, Northwestern University Feinberg School of Medicine, NMH/Galter Room 14-100, 675 N. St. Clair, Chicago, IL, 60611, USA. e-ruderman@northwestern.edu.

Abstract

A treat to target (T2T) approach to management has become the standard of care for patients with rheumatoid arthritis (RA). While consensus T2T recommendations call for patient involvement in the treatment process, the targets commonly used to drive therapeutic decisions involve limited patient input. A pilot study was developed to explore whether the Patient-Reported Outcomes Measurement Information System (PROMIS) could add value to the T2T approach by providing a way to bring patient goals into the process. We report here the baseline data from this study. RA patients from an academic rheumatology practice were recruited to participate in this 1-year study. Patients were asked to complete PROMIS computer-assisted testing at quarterly visits during the year. At baseline, they were asked to identify the PROMIS domain (Pain Interference, Fatigue, Depression, Physical Function, and Social Function) that felt most important to their quality of life. They were then asked to select five representative items from this domain, to be followed through the year. Complete baseline data was available for 119 patients. Most selected Physical Function (39%) or Pain Interference (37%) as their highest priority PROMIS domain. Sixty percent ranked Depression as their lowest priority domain. Younger patients more frequently prioritized Social Function, while older patients more frequently prioritized Fatigue. The incorporation of PROMIS questionnaires into routine clinic visits is a feasible mechanism for incorporating patient preferences into a T2T approach to managing RA.