Rheumatoid Arthritis

This article published in Rheumatology and Therapy by Radawski et al. identifies and quantifies the unmet needs perceived by United States patients with Rheumatoid Arthritis (RA) currently taking a disease-modifying antirheumatic drug (DMARD). 258 patients were surveyed and only 26% of patients reported that they were satisfied with their RA treatment. Patients not satisfied with their treatment reported higher rheumatic disease impact and half reported a current flare. There is a need for improved disease management among RA patients.

Hsiao et al. conducted a pretest/post test study with RA patients who had outpatient visits using 5 phenotypic groups that clarified patient desires. Clinicians were introduced to the phenotypic groups. The authors found greater evidence of shared decision-making in the post test phase of the study as patients were offered more choices and more visits in which patients vocalized their values and/or preferences and providers were more likely to base their recommendations on patients’ values and/or preferences. Allowing patients to consider a set of preference phenotypes can support shared decision-making.

In Arthritis Research & Therapy, Gavigan et al. report on Rheumatoid Arthritis (RA) patients’ beliefs on factors that influence their physician’s treatment decisions, reasons patients tolerate sub-optimal disease control, and perceived barriers to treatment optimization. Eligible participants were enrolled in the ArthritisPower registry and completed a survey on barriers to treatment optimization and patient-reported outcomes on symptoms of fatigue, sleep disturbance, and physical function. Most participants trusted their doctor’s treatment decisions and prioritized their physician’s treatment goals over their own.

To facilitate better shared decision-making at the point of care for patients failing methotrexate monotherapy, Fraenkel et al. developed preference phenotypes or profiles to measure the preferences of patients with Rheumatoid Arthritis (RA) for triple therapy, biologics, and Janus Kinase (JAK) inhibitors. The authors surveyed 1,273 participants and developed 5 groups to classify patients: most strongly impacted by the cost of medication, most strongly influenced by the risk of bothersome side effects, most concerned with the risk of very rare side effects, strongly prefer oral over parenteral medications, and most strongly and equally influenced by onset of action and the risk of serious infections. These results show that there is variability in patients’ values, and it is important to use a shared decision-making approach in implementing treatment.

In this study, ten patients with Rheumatoid Arthritis (RA) completed 8 hours of training on evidence-based medicine and guideline development and formed a patient panel to apply the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology to formulate recommendations for a survey containing clinical questions created by a physician-dominated panel. Fraenkel et al. reports that patients and physicians developed the same recommendations for most questions and that additional experiences are necessary to determine panel composition for future guidelines.

Methotrexate (MTX) is a prominent treatment for patients with Rheumatoid Arthritis (RA) but its effectiveness may be impacted by bothersome side effects and lack of tolerability. This cross-sectional study by Curtis et al. surveyed RA patients who were members of CreakyJoints who participated in subcutaneous or oral MTX treatment in the last 12 months. 382 patients were surveyed, and they reported side effects such as diarrhea, fatigue, malaise, and hair loss. Higher doses of MTX were associated with a greater likelihood of more side effects.