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Patient- and Rheumatologist- Perspectives Regarding Challenges to Achieving Optimal Disease Control in Rheumatoid Arthritis

Author

Owensby JK1, Chen L1, O'Beirne R2, Ruderman E3, Harrold LR4, Melnick JA1, Safford MM5, Curtis JR1, Danila MI1. Arthritis Care Res (Hoboken). 2019 Apr 22. doi: 10.1002/acr.23907. [Epub ahead of print]

Author Information

1 Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL.

2 Division of Continuing Medical Education, University of Alabama at Birmingham, Birmingham, AL.

3 Department of Medicine, Division of Rheumatology, Northwestern University, Evanston, IL.

4 Departments of Medicine and Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, Worchester, MA.

5 Division of General Internal Medicine, Cornell University, New York, NY.

Abstract

OBJECTIVE: 

To identify and prioritize patient- and rheumatologist-perceived barriers to achieving disease control.

METHODS: 

RA patients and rheumatologists from the Consortium of Rheumatology Researchers of North America (Corrona) registry were invited by email to participate in nominal groups (NGs). Two separate lists of barriers were created, one from RA-patient-only NGs and other from rheumatologist-only NGs, and barriers were sorted into themes. Next, using an online survey a random sample of RA patients from Corrona registry were asked to rank their top three barriers to achieving disease control.

RESULTS: 

4 NGs with 37 RA patients identified patient-barriers to achieving control of RA activity that were classified into 17 themes. 3 NGs with 25 rheumatologists identified barriers that were classified into 11 themes. Financial aspects of RA care ranked 1st for both types of NGs, while medication risk aversion ranked 2nd and 3rd among the physician- and patient-NG-generated barriers, respectively. Among the 450 RA patients surveyed, 77% considered RA a top-health priority, and 51% reported being aware of the treat-to-target (T2T) strategy for RA care; the three most important patient-perceived challenges to achieving disease control were RA prognosis uncertainty, medication risk aversion and the financial/administrative burden associated with RA care.

CONCLUSION: 

There are common, potentially modifiable, patient- and rheumatologist-reported barriers to achieving RA disease control, including perceived medication risk aversion, suboptimal treatment adherence, and suboptimal patient-physician communication regarding the benefits of tight control of disease activity in RA. Addressing these obstacles may improve adherence to goal-directed RA care.