Session Information
Date: Monday, November 6, 2017
Session Title: Rheumatoid Arthritis – Clinical Aspects Poster II: Pathophysiology, Autoantibodies, and Disease Activity Measures
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose:
The 2015 ACR RA treatment guidelines focus on measuring disease activity and provide a guideline driven treat to target strategy. We hope to understand patients’ personal choices of disease measures and treatment targets and how it compares to their physicians.
Methods:
This is a cross sectional study of the first 120 RA patients defined by the 1987 or 2010 ACR criteria seen in our clinic from 1/16/17 to 3/13/17.
Before the routine care visit, each patient was given a questionnaire of traditional and personalized RA measures and asked which they prefer using to determine their treat to target goal. The patient was asked to rank each traditional (disease activity, functional status, patient global, physician global, joint pain/swelling) and personalized (ADLs, exercise, work, leisure, sleep) measure 1 to 5 (1 – most important and 5 – least important). Physicians completed the survey for each respective patient. Comparisons were made on both traditional and personalized physician and patients’ ranking responses.
Percent agreement, Wilcoxon signed rank test and weighted kappa coefficients were used to understand the change in agreement between physicians and patients.
Results:
Most patients (70%) and physicians (64%) believe a combination of traditional and personalized measures should be used to determine their RA treatment goal (Table 1).
|
Table 1: Physician and Patient Preference for Traditional vs. Personalized Measures |
||
|
Physicians |
Patients |
|
|
Traditional |
3 (27.3%) |
17 (14.2%) |
|
Personalized |
1 (9.1%) |
9 (7.5%) |
|
Combination |
7 (63.6%) |
84 (70.0%) |
|
Neither |
0 (0%) |
10 (8.3%) |
As an overall group, both patients and physicians believe that functional status and disease activity are the most important traditional measures based on average ranking. Also, there is agreement in joint pain/swelling (p=0.36). Being able to complete ADLs is the most important personalized measure based on average ranking (Table 2).
|
Table 2: Overall Physician and Patient Preference Average Ranking (1 to 5) (1 being most important, 5 being least important) |
||
|
Traditional Measures |
Physician |
Patient |
|
Functional Status |
1.8 |
2.2 |
|
Disease Activity |
2.1 |
2.9 |
|
Tender/Swollen Count |
2.5 |
2.7 |
|
Patient Global |
4.0 |
3.2 |
|
Physician Global |
4.6 |
4.1 |
|
Personalized Measures |
Physician |
Patient |
|
ADLs |
1.2 |
1.5 |
|
Work |
3.2 |
3.5 |
|
Travel/Leisure |
3.3 |
3.8 |
|
Sleep |
3.4 |
2.8 |
|
Exercise |
3.9 |
3.4 |
On an individual level, patient and physician level of agreement measured by weighted kappa coefficient is random (-0.024 to 0.283) and percent agreement showed a low of 20% (95% CI: 12.8%, 27.2%) for disease activity and high of 62% (95% CI: 53.0%, 70.4%) for ADLs.
Conclusion:
To our knowledge, this is the first study to analyze patient preference in addition to a treat to target management of RA.
Using disease activity as a measure for a treat to target approach has improved RA patient care. However, this study shows that on an individual patient level, even physicians who know their patients well cannot predict what measure(s) are most important to them as an individual.
To provide population care that is patient-centered, we recommend setting a patient specific measure/goal (traditional or non-traditional) based on personal importance in addition to following guideline driven care (i.e. disease activity measure).
To cite this abstract in AMA style:
Dunn P, Cote J, Newman E, Kirchner L. Treat to Target: What’s the Target? [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/treat-to-target-whats-the-target/. Accessed December 7, 2019.« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/treat-to-target-whats-the-target/