Background/Purpose: Depression prevalence in patients with rheumatoid arthritis (RA) is higher than the general population (~40% and 4.1%, respectively). Patients with depressive symptoms show reduced biologic therapy response. Patient-clinician goal concordance has been linked to improved outcomes in other chronic conditions including diabetes but has not been explored in RA patients with depression. Our objective was to (a) describe treatment goals for RA patients with and without depression and (b) assess whether RA patient-clinician goal concordance varies by depression status.

Methods: RA patients seen in the prior 12 months at one of two rheumatology clinics (Veterans Affairs- and university-based) were enrolled in a cross-sectional survey study. Patients and their rheumatology clinician independently ranked their top three (of eight) RA treatment goals. PHQ8 score ≥10 defined depression. Descriptive statistics were used to characterize treatment goals for both groups. Fisher’s exact test was used to determine statistical significance with a Bonferroni correction to account for multiple comparisons (p= 0.006). Goal concordance, defined as a patient’s top goal ranked in their clinician’s top three goals, was compared between groups.

Results: 148 dyads were included in the analysis (148 patients, 14 clinicians). Patients were 51% female and 28% non-white, with mean disease duration of 12 years (SD= 9). 32 patients (22%) met depression criteria. Overall, “less pain” was identified as a treatment goal most often, regardless of depression status (81% depressed, 91% non-depressed, p= 0.21). Similarly, “fewer problems doing my daily activities” was the second-most selected treatment priority for patients with and without depression (56% and 69%, respectively, p= 0.21). However, patients with depression identified “feel less tired” as their third-most selected goal (47% depressed, 33% non-depressed, p=0.15), while those without depression identified “avoid side effects from medication” third-most frequently (41% non-depressed, 28% depressed, p=0.22). Patients with depression also identified “improve sleep” as a goal more often than patients without depression (41% depressed, 16% non-depressed, p= 0.006). Goal concordance did not differ significantly between patients with and without depression (91% and 78% meeting concordance definition, respectively, p= 0.1).

Conclusion: RA patients, regardless of concomitant depressed mood, most often prioritized “less pain,” followed by “fewer problems doing my daily activities.” However, differences emerged in the third-most valued goal such that patients with depression ranked “feel less tired” and patients without depression ranked “avoid side effects from medication” more often. Goal concordance did not differ significantly between groups, which may be explained by the high value placed on pain in goal ranking and our patient-centered definition of concordance. Pain is a common symptom in RA and routinely elicited at clinic visits, prompting discussions between patients and clinicians. Research to explore ways to improve goal elicitation beyond pain among all RA patients and their clinicians is warranted.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/goal-concordance-in-rheumatoid-arthritis-patients-with-depression-what-do-patients-prioritize/