Results of a large patient survey announced during this year's American College of Rheumatology (ACR) meeting suggest more than half of rheumatoid arthritis (RA) patients in Western Europe and the US feel their disease is not managed intensively. This implies specific targets are not set for them or progress monitored at regular intervals (1).
A total of 1892 recently-diagnosed patients with moderately severe RA from USA, UK, France, Germany, Italy and Spain took part in the internet-based survey, led by Dr Vibeke Strand of Stanford University, Palo Alto, California.
The survey found 60 per cent of patients overall had never heard of the "treatment-to-target" approach to RA disease management. (Treatment-to-target aims for remission or low disease activity following appropriate disease-modifying treatment, with regular follow-up every 1-3 months during active disease to monitor progress. Various measures are used to assess disease activity with the ultimate aim of preventing joint destruction and preserving function. Assessment can include patients' own assessments of their physical function, pain and general health status. Therapy is adapted when appropriate to reach the desired goal within 3 to 6 months maximum). (2).
In the survey the same proportion overall (but 70 per cent in the US) said their healthcare provider (HCP) was not currently managing their RA intensively with strict goals and timelines in place. Only 44 per cent believed developing and adhering to a strict treatment plan was important but 75 per cent expected to feel an improvement (other than pain relief) within three months when given a medicine for their RA signs and symptoms. When starting a new treatment 91 per cent of respondents said they set themselves treatment goals, 81 per cent set personal or social goals and 80 per cent felt these would be of benefit to assess whether a treatment was working. Examples of personal and social goals were being able to walk for longer distances without pain, feeling like going out more, sleeping better and being less depressed, having energy to play with children or grandchildren, sleeping through the night without pain and being able to grip household implements.
The investigators reported: "Despite the majority of respondents having shared decisions with their HCP, 73 per cent stated that their HCP did not discuss treating RA with an approach that achieved personal or social targets."
In conclusion, the investigators said a targeted approach from the patients' perspective meant setting personal, social and treatment goals and having progress monitored in achieving them. "As more treatments become available for RA, these expectations of people with RA are likely to increase."
1. Strand V, Taylor P. Sensky T et al. Patient expections of treatment goals and goal-setting practices in rheumatoid arthritis. Arthritis & Rheumatism, Vol 63, Number 10 (supplement), p.45 abstr 106.
2. Smolen JS, Aletaha D et al. Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis 2010:69:631-7.