Background/Purpose: ACR guidelines for treating Rheumatoid Arthritis (2015) suggest that treatment decisions should be made by physicians and patients through a shared decision-making process taking into account patients’ values, preferences, and comorbidities. Identifying the impact of patient involvement on disease outcomes in biologic patients would provide further evidence which could support ACR guideline recommendations and be used to inform optimal disease management.

Methods: A multi-center medical chart review study of patients with RA was conducted in Q4 2016 among physicians in hospitals and private practices to collect de-identified data on patients who were recently treated with a biologic as part of usual care in the USA. Physicians were screened for duration of practice (3-30yrs) and patient volume (≥2 RA biologic patients/week) and recruited from a large access panel to be geographically representative of the country. Eligible patient charts (≥5) were randomly selected from among the patients visiting each center/practice during the screening period. Physicians abstracted date of diagnosis, treatment patterns/dynamics, and symptomatology/disease status. Physicians identified the level of patient involvement in treatment decision making using a 7 point scale, and patient records were segmented into low-medium involvement (1-4/7) and high involvement (5-7/7). Sites waived local ethics review owing to collection of retrospective de-identified data. High involvement versus low involvement patients were compared using descriptive statistics.

Results: 517 biologic RA patients were assessed; overall, Highly involved: 409 (79%), Low-mid involved: 108 (21%). Patient characteristics (Highly involved/Low-mid involved) included: age (in years) 50/54; full time employment status 57%/42%; co-existing conditions: obesity (14%/28%), dyslipidemia (19%/33%), depression (19%/28%), none (45%/24%). Time since diagnosis (in months): 52.2/48.3. Among patients with available data, current lab measures included: ESR(mm/h) 20.3/24.0; CRP(mg/l) 2.8/3.8; rheumatoid factor(positive) 89%/84%; anti-CCP(positive) 80%/72%; measures of disease severity included: disease severity per physician judgment: mild (72%/53%), moderate (25%/40%), severe (3%/7%); disease under control 80%/69%; remission 63%/52%; mean DAS 28 2.7/3.2; mean tender joint count 3.4/3.6; mean swollen joint count 2.3/2.4.

Conclusion: In this cohort of RA patients in the USA, majority of patients with high involvement were seen to be younger, healthier patients who were full time employees. These patients were significantly more likely to be considered as mild disease severity (physician judgement) with a higher proportion in remission. Lab measures indicated lower disease burden with low hematology scores for highly involved patients. Further investigation of the influence of socioeconomic status, insurance type, and other demographics on patient involvement in treatment may warrant further research.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/effect-of-patient-involvement-in-treatment-decision-making-on-disease-outcomes-in-rheumatoid-arthritis-in-the-usa/