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

Abstract

ObjectiveTo identify and prioritize patient‐ and rheumatologist‐perceived barriers to achieving disease control.MethodsPatients with rheumatoid arthritis (RA) and rheumatologists from the Corrona registry were invited by e‐mail to participate in nominal groups. Two separate lists of barriers were created, 1 from RA patient–only nominal groups and the other from rheumatologist‐only nominal groups, and barriers were sorted into themes. Next, using an online survey, a random sample of RA patients from the Corrona registry were asked to rank their top 3 barriers to achieving disease control.ResultsFour nominal groups totaling 37 RA patients identified patient barriers to achieving control of RA activity that were classified into 17 themes. Three nominal groups totaling 25 rheumatologists identified barriers that were classified into 11 themes. The financial aspects of RA care ranked first for both types of nominal groups, while medication risk aversion ranked second among the perceived barriers of the physician nominal group and third among those of the RA patient nominal group. Among the 450 RA patients surveyed, 77% considered RA a top health priority, and 51% reported being aware of the treat‐to‐target strategy for RA care; the 3 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.ConclusionThere 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.

The association between comorbidities and disease activity in patients with rheumatoid arthritis: a multicenter, cross-sectional cohort study in Japan with the highest proportion of elderly individuals

“…Another possible interpretation is that patients with a history of cerebrovascular disease are not being treated appropriately. In fact, the physical limitations of patients have been reported to be barriers to achieving optimal disease activity [18], and the usage rate of biologics has been reported to be lower in patients with cerebrovascular disease because this comorbidity is attributed to increased fragility [28]. In this study as well, a high Steinbrocker class was a risk factor for high disease activity in the multivariate logistic regression analysis; impaired physical function was associated with high disease activity.…”

“…Using our patient registry with a high proportion of elderly patients, we found that cerebrovascular disease was associated with high disease activity in patients with RA, among the comorbidities studied. Since patients from the registry had a higher average age of 66.4 years, and a higher prevalence of cardiovascular disease (8.0%) and cerebrovascular disease (4.7%) than those in other reports [4,8,18], this finding has important implications for the treatment of rheumatoid arthritis in the elderly.…”

Barriers, facilitators, preferences and expectations of joint protection programmes for patients with hand arthritis: a cross-sectional survey

“…Financial burden and time have been previously described for patients with RA as a perceived barrier. 25 26 From the qualitative analysis barriers associated with health factors were novel, and not well captured in the survey.…”

Evaluation of an Intervention to Support Patient‐Rheumatologist Conversations About Escalating Treatment in Patients with Rheumatoid Arthritis: A Proof‐of‐Principle Study

“…and "What is the difference between joint inflammation and joint damage?" These questions were generated in response to patient-and rheumatologist-identified barriers to T2T in RA (12) and were designed to showcase the benefits of a T2T strategy, as well as address potential patient concerns such as worsening symptoms and the medication side effects some experience when making a medication change. Videos had a mean duration of 2 minutes.…”

“…Many factors contribute to the observed clinical inertia about RA treatment escalation, including patient–physician therapeutic alliance ( 9 ), topics discussed at the visit, patient satisfaction with the clinical visit ( 10 , 11 ), knowledge about the advantages of following a T2T approach ( 12 ), and variable response to a treatment change ( 13 ). In addition, many patients with RA are concerned about the adverse effects associated with frequently prescribed medications ( 14 , 15 ).…”