Rheumatology Patients and Doctors Same Barriers, Common Concerns

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Rheumatoid arthritis patients and rheumatology providers share many of the same concerns over obstacles that make it harder to reach treat-to-target goals, according to a new study.

Based on research published in the April issue of Arthritis Care & Research, investigators identified several barriers that prevent patients from getting the disease under control. Even though the study revealed patients were mostly unfamiliar with the treat-to-target concept, it’s largely believed effective treat-to-target therapy requires patient-physician collaboration. And, in many cases, falling short can increase both patient morbidity and mortality.

“There are common, potentially modifiable, patient- and rheumatologist-reported barriers to achieving rheumatoid arthritis disease control,” said study author Maria Danila, M.D., associate professor of immunology and rheumatology at the University of Alabama at Birmingham. “Addressing these obstacles may improve adherence to goal-directed rheumatoid arthritis care.”

To identify the challenges to controlling the disease, investigators surveyed 37 patients, 24 rheumatologists, and one rheumatology nurse practitioner. Clinicians were mostly male and were, on average, age 54. Patients were mostly female and were, on average, age 53.

Overall, the biggest concerns among rheumatology providers were treatment-related costs and administrative issues, such as prior authorization requirements. Patient medication risk aversion and concerns about clinical tool efficacy and efficiency also topped the list.

Patients with rheumatoid arthritis were most concerned by uncertainty surrounding rheumatoid arthritis prognosis, perceived risk aversion to treatment escalation, and the financial/administrative burden associated with treatment. It’s important to note, researchers said, that only two-thirds of patients tightly adhere to their DMARD therapy due to co-morbid conditions, cost, side effects, adverse events, and lack of trust in their provider.

However, one study finding was novel, investigators said. While length of disease duration did not impact perceived barriers, patients did prioritize obstacles based upon their previous use of biologic DMARDs. Those with prior exposure gave financial and administrative burdens a higher priority than those without existing treatment. It was assumed their knowledge base informed their choices.

According to these results, researchers said, a behavioral intervention could help patients become better informed about and engaged in evidence-based rheumatoid arthritis care. Such additional information could prompt conversations between patients and physicians that could lead to greater shared decision-making, ultimately improving adherence to goal-directed rheumatoid arthritis care.

REFERENCE

Owensby J, Chen L, O’Beirne R, Ruderman E, Harold L, Melnick J, Sanford M, Curtis J, Danila M, Patient-and Rheumatologist-Perspectives Regarding Challenges to Achieving Optimal Disease Control in Rheumatoid Arthritis. Arthritis Care & Research (2019), doi: 10.1002/acr.23907