Background/Purpose:

The treat to target (T2T) approach has become part of the standard of care in RA management. Implicit in this approach is patient involvement in shared decision making, to ensure that treatment decisions meet the needs of the patient as well as the goals of the provider. The Patient Reported Outcomes Measurement Information System (PROMIS) is a validated set of assessment tools to measure patient reported health status across a variety of medical conditions. We sought to learn whether the use of elements from PROMIS could inform the T2T approach, and to understand whether patient reports of disease impact correlate with objective clinical measures. We report here the baseline status of the patients enrolled in the study.

Methods:

Patients with a diagnosis of RA by 2010 criteria were recruited from our academic clinical practice. Patients were stratified at baseline by disease activity (remission or low disease activity, CDAI ≤ 10 vs. moderate or high disease activity, CDAI > 10), and we made an effort to balance the 2 groups. Patients will be treated for 1 year, using a T2T approach that recommends consideration of therapeutic escalation when CDAI > 10, with data collected at routine clinic visits. At each visit, we collect standard RA assessments, including joint counts, RAPID3, and CDAI scores. Patients complete a PROMIS assessment quantifying their health status in 5 domains: pain, fatigue, depression, physical function, and social function. Patients are also asked to select priority targets, consisting of 5 items from the domain they deem most important; answers to these questions are also collected at each visit. Table 1 shows the demographics, clinical status and PROMIS measures for the first 94 patients enrolled.

Results:

Compared to the US general population reference values for PROMIS (m=50; SD=10), patients had worse fatigue (m=56.7), pain (m=57.7), and physical function (m=42.3). Baseline scores on depression and social functioning were close to the average of the general US population. Patients with CDAI > 10 scored worse across all domains than those with CDAI  ≤ 10. When selecting prioritization areas for treatment targets, 38% of patients selected physical function, followed by 35% of participants selecting pain, 16% selecting fatigue, 6% selecting depression, and 4% selecting social function; those with active disease were much more likely to select pain (45% vs. 18%).

Conclusion:

Pain, physical function, and fatigue, the 3 domains in which patients reported worse health status than the general population, were also the areas most frequently selected by patients as priority targets for treatment. Physicians are informed of the PROMIS scores at each visit, and we will track their impressions of the impact of these data on their treatment decisions. We will also explore, at a patient level, the correlation between PROMIS scores and standard disease activity measures

Table 1

*Baseline CDAI not recorded in 7 patients

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/personalizing-the-treat-to-target-approach-in-rheumatoid-arthritis/