Background/Purpose: Shared decision making and treat to target are recognized guidelines to treat Rheumatoid Arthritis (RA). We previously reported associations of shared treatment goal discussions to greater disease activity (DA) improvement and satisfaction with rheumatology care. Further, only 37% of RA patients surveyed recall having shared goal discussions with providers. Building on our previous reports, we aimed to gain insight to the nature of patient treatment goals and their role in RA management.

Methods: An anonymous online questionnaire was presented in 2019 on a secure survey system. Participants were U.S. residents ≥18 years of age with a self-reported RA diagnosis by a medical professional. They responded to questions on demographics, RA disease activity, diagnosis and DMARD history, improvement from treatment, and RA treatment goals. Patients’ treatment goals were thematically coded and verified for reliability by a team using qualitative content analysis. If >1 goal was conveyed, both were coded; “To be able to do daily activities without so much pain” mentioned both ADL and pain goals.

Results: The questionnaire was completed by 907 RA patients (90% women, 10% men), with 58 (11) years mean (SD) age and 11 (10) years since diagnosis. In response to the question “What are your goals for RA treatment?”, 95% recorded responses (n=861). Fifteen themes were identified, 8 of them present in ≥20% of respondents. Major themes were function 59%, pain 53%, stopping disease progression 30%, extra-articular disease effects 26%, medication 21%, communication with providers 21%, remission 20%, and less disease activity 20%. Function goals included 3 subthemes: activities of daily living (ADL) 31%, lifestyle 18%, and being active 10%. Subthemes in extra-articular goals included constitutional health 17%, overall health 5%, and organ involvement 4%. Minor themes included very modest goals 7%, nontraditional medicine 4%, understanding 3%, story but no goal 2%, cure 1%, hopelessness 1%, and hope 0.7%. Major themes associated with DA levels, time to treatment, shared goal discussions, and presence of treatment plans. Higher DA associated with goals related to pain or ADL; lower DA related to goals of lifestyle, being active, and stopping disease progression. Examples of typical treatment goals: “Significant pain reduction”; “Limit joint damage”; “Able to maintain all independence.”

Conclusion: This RA patient survey found previously unreported themes in patients’ treatment goals, which associated with aspects of rheumatology care such as presence of a treatment plan or a shared goal discussion as well as RA disease activity. Our study is unique in coding patient treatment goals by common themes. Further research should seek greater understanding of patient treatment goals and investigate their significance in RA outcomes.

Parameters that associate with patients’ top RA treatment goals With certain parameters, particular RA treatment goals are more likely.

RA Patients Whose Treatment Goals Are Related to Pain: Figure 1. Respondents describing their RA treatment goals using “pain” (or a synonym for pain) are divided by their replies to the question ”What is your current level of RA DA?”

Frequency of ADL Goals by Time Before RA Diagnosis: Figure 2. Patients describing their RA treatment goals as relating to activities of daily living (ADLs) were asked how long they had RA symptoms prior to diagnosis.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/rheumatoid-arthritis-patients-treatment-goals-relate-to-disease-activity-and-rheumatology-experiences/