Background/Purpose: Patients satisfaction with their treatment is important for adherence to medications, particularly for chronic conditions such as rheumatoid arthritis (RA). The aim of this analysis was to explore the relationship between patient satisfaction with treatment and features of disease activity as well as to identify thresholds of disease severity optimally associated with satisfaction of RA patients treated in routine clinical care.  

Methods: Abatacept Best Care (ABC) is a prospective, multicenter, observational study of patients with RA starting subcutaneous abatacept. Patient expectations in regard to RA activity, pain, function, and fatigue were assessed at baseline using a VAS mm scale (0=no expectation, 100=highest expectation), and patient satisfaction with treatment for each aspect during treatment was assessed in a similar fashion. The correlation of patient satisfaction at 6 and 12 months and TJC28, SJC28, physician global (MDGA), patient global (PtGA), DAS28, CDAI, RAPID3, HAQ, pain, and fatigue (and changes from baseline in these variables) was assessed with the Pearson’s correlation coefficient (r). ROC analysis was used to identify thresholds of CDAI, pain, HAQ, and fatigue optimally associated with patient satisfaction (>50mm).

Results: 275 patients (74.8% females) were included with a mean (SD) age of 59.7 (11.7) years and disease duration of 7.4 (8.7) years. At baseline, mean (SD) parameters were: CDAI (30.0 [10.7]), pain (64.6 [23.4]), HAQ (1.5 [0.6]), and fatigue (63.3 [23.4]); patient expectations were: RA activity (70.3% [23.9]), pain (72.1% [24.4]), function (71.1% [23.8]), and fatigue (69.1% [25.7]).

At 6 months, weak-to-moderate negative correlations (0.2<r<0.6) were observed between patient satisfaction with treatment and all parameters studied, the strongest being with MDGA, DAS28, CDAI, PtGA, and pain. Similar results were observed at 12 months, however patient satisfaction with treatment in terms of function was only correlated (moderately) with DAS28. Regarding the correlation of patient satisfaction with changes from baseline in disease parameters, again, weak-to-moderate negative correlations were observed which were lower at 12 months compared to 6 months. No correlation between patients with high expectations of treatment outcome and satisfaction was observed at any time.

In ROC analysis, optimal thresholds of disease severity were identified for all aspects of patient satisfaction which showed statistically significant (p<0.001) fair precision (ROC≈0.7; Table 1).

Conclusion: Weak-to-moderate correlation was observed between patient satisfaction with treatment and various outcomes. Specific thresholds corresponding to moderate disease activity, moderate and mild pain at 6 and 12 months, respectively, and mild functional disability and fatigue were identified which could be targeted in routine clinical care.