SAN FRANCISCO – Patients believe that setting specific goals at the beginning of a new therapy will help them achieve optimal treatment outcomes, in a slight variation of the treat-to-target mantra heard so widely in rheumatology these days.
Findings from an unpublished survey of 1,242 women and 587 men with moderate rheumatoid arthritis (RA) disease severity showed that at the start of treatment, 81% set personal or social goals (ability to garden or stand at a cocktail party), with 80% saying that the setting of such goals would be a good way to assess whether the new treatment was working; 91% set treatment goals (an MRI will show less inflammation in the joint), according to Dr. Vibeke Strand.
Most patients (87%) agreed that establishing such targets and achieving them would have a positive impact on their disease management.
Patients’ perceptions of goal setting included:
• I think setting personal and social goals would be of benefit as I can then assess whether my treatment is working or not in a simple to understand way (80% agreed).
• A treatment that works gets me to my personal and social goals quickly (84% agreed).
• If I set myself personal and social goals and achieve them, I would feel positive (87% agreed).
But they expected rapid results. About 81% wanted a new treatment to make them feel better within 3 months, and 56% said they would talk with their physician within less than a month of starting a new treatment if they felt no improvement, said Dr. Strand, adjunct clinical professor in the division of immunology at Stanford (Calif.) University.
A few were willing to give a new treatment longer to produce a benefit, with 20% saying they expected improved signs and symptoms within 3-6 months; only 5% were willing to wait more than 6 months.
Patients are just as impatient with their physicians as with their treatments. A total of 11% cited their physician as the biggest obstacle in controlling RA. Another 54% said that the leading challenge was finding the right treatment, and 16% named lack of education and understanding of RA. The remainder was made up of 11% who said lack of personal resolve was their biggest obstacle, and another 8% listed assorted other issues.
Over half of those surveyed (60%) had not heard of the treat-to-target approach to RA therapy. According to 61%, their physician did not manage their RA with strict goals and timeframes in place. But 62% said that they shared decisions with their physician on how best to treat their RA, Dr. Strand said at the Pespectives in Rheumatic Diseases 2011 meeting, which was sponsored in part by the Skin Disease Education Foundation (SDEF).
This survey was a follow-up to an earlier one of 1,958 women with RA from seven countries, including the United States, which was the first to characterize in detail the impact RA has on the daily lives of women and on their relationships. The survey was conducted on the Internet; all the women had been vetted as having RA of at least 6 months duration and all were 25-65 years of age.
The bottom line from that survey is that well into the era of biologics, women with rheumatoid arthritis report that pain remains a frequent and disabling symptom of their disease. Daily pain was reported by 63% of the women surveyed; 75% said they took pain medication daily, and 87% said they found it important to be able to describe the type and frequency of their RA-associated pain. Overall, 67% of the women reported that they constantly look for new ways to cope with their pain. When asked to describe a "good day with RA," 57% said it was a day free from pain, 58% said it was a day without fatigue, and 29% said it was a day when they were able to do everything easily.
Of the surveyed women, 68% reported that they felt it was necessary to conceal pain from their family and/or coworkers.
Regarding the effects of RA on their activities of daily living, 49% said it was difficult to keep fit, 45% found it difficult to garden, and 67% reported feeling less self-confident at work. Of the women who had been employed full time at diagnosis, 23% of the women had stopped working because of their disease and 27% reported they had cut back their work hours to part time.
The impact of RA extended beyond the workplace: 32% of the women said RA affected their closest relationships, with 55% reporting that they felt less confident in their sexuality; 31% reporting that they found it difficult to explain their sexual needs; of the 611 women who were single, 40% said RA played a role in it being difficult to find a partner.