Outcomes in rheumatoid arthritis: incorporating the patient perspective

Abstract

Recent studies have shown both that rheumatologist and patient approaches to achieving wellness differ and providing patients with a sense of control in reaching that state of wellness leads to better outcomes. Current research is focused on evaluating how best to measure the patient assessments and incorporate the patient voice into the clinic.

Chronic stress and regulation of cellular markers of inflammation in rheumatoid arthritis: Implications for fatigue

“…Fatigue is increasingly recognized as an important factor contributing to quality of life in RA patients, and persistent fatigue is one of the biggest obstacles to optimizing function in these patients (Heller and Shadick, 2007). Progression of RA disease varies considerably from person to person, and is affected by a range of immune, neuroendocrine, and psychosocial factors (Uhlig et al, 2000).…”

Osteoimmunology at the nexus of arthritis, osteoporosis, cancer, and infection

“…Where the pannus tissue encroaches on periarticular bone, erosions occur through coupling of inflammation to osteoclast formation. Damage to articular cartilage and periarticular bone results in irreversible joint dysfunction and reduces quality of life (17). Knowledge of these basic mechanisms of RA pathogenesis has led to clinical approval of targeted biologic therapeutics that (a) block proinflammatory cytokines, (b) interrupt T cell costimulation, and (c) deplete B cells (18,19).…”

Shared decision-making in rheumatology : what matters to patients?

“…However, some indicated that they had missed information on how medication could affect their daily lives or how to minimize the impact of the administration schedule on their daily lives. The need to stay in control and the need for practical information is in line with studies showing that patients prioritize treatment outcomes related to quality of life (129)(130)(131)(132)(133)(134)138). To increase patients' involvement in medical decisionmaking, it is essential to not only inform patients about clinical elements of the treatment, but also about the impact on lifestyle, control and comfort.…”

“…If patients completely rely on the expertise of their rheumatologist, they may fail to recognise the potential value of their own input (38). Since rheumatologists' and patients' beliefs about treatment differ (120,(129)(130)(131)(132)(133)(134)(135)(136)(137)(138)(139), the input of patients seems important. Moreover, patients' adherence to treatment might increase if it matches their preferences.…”

“…Furthermore, patient participation is important because studies show that patients' and rheumatologists' beliefs about illness and treatment may differ. This includes how they rank the potential benefits and side effects of available treatment options and how they prioritize long-term outcomes (120,(129)(130)(131)(132)(133)(134)(135)(136)(137)(138)(139). Therefore high quality patient-physician communication about the choice of treatment is important.…”