The patient perspective on remission in rheumatoid arthritis: 'You've got limits, but you're back to being you again'

van Tuyl, Lilian H D; Hewlett, Sarah; Sadlonova, Martina; Davis, Bev; Flurey, Caroline A; Hoogland, Wijnanda; Kirwan, John; Sanderson, Tessa; van Schaardenburg, Dirkjan; Scholte-Voshaar, Marieke; Smolen, Josef; Stamm, Tanja; Boers, Maarten

Abstract

© 2015, BMJ Publishing Group. All rights reserved. Objectives: The aim of rheumatoid arthritis (RA) treatment is remission. As treatment should be targeted at outcomes relevant to patients, it is important to understand how patients perceive remission, and to assess whether the current definition of remission adequately reflects these perceptions. The objective of this study is to explore the patient perspective on remission in RA. Methods: Nine focus-group discussions in Austria, The Netherlands and UK were conducted, including patients in American College of Rheumatology (ACR)/ European League of Rheumatology (EULAR) remission, self-declared remission and in moderate/high disease activity. Moderators employed a prespecified interview guide helped to engage patients in a discussion on their experience with remission. Inductive thematic analysis was performed within each country, and identified themes were discussed across countries. Results: 47 RA patients (66% women, disease duration 9 years) participated. Three major themes of patient-perceived remission emerged: (1) symptoms would either be absent or strongly reduced, (2) impact of the disease on daily life would diminish by increased independence, ability to do valued activities, improved mood and ability to cope; (3) leading to a return to normality, including work, family role and perception of others. Patients felt the concept of remission was influenced by ageing, side effects of medication, comorbidities, accrued damage to joints and disease duration. Opinions on duration of state, the role of medication and measurement instruments varied widely. Conclusions: Patients characterise remission by the absence or reduction of symptoms, but more directly by decreased daily impact of their condition and the feeling of a return to normality. The next step is to study whether an additional patient-perceived measure of remission may add value to the ACR/EULAR definition of remission.

• Journal Article Type: Article
• Publication Date: Jun 1, 2015
• Deposit Date: Sep 11, 2015
• Publicly Available Date: Jun 15, 2016
• Journal: Annals of the Rheumatic Diseases
• Print ISSN: 0003-4967
• Electronic ISSN: 1468-2060
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 74
• Issue: 6
• Pages: 1004-1010
• DOI: https://doi.org/10.1136/annrheumdis-2013-204798
• Keywords: remission, rheumatoid arthritis, patient
• Public URL: https://uwe-repository.worktribe.com/output/821209
• Publisher URL: http://dx.doi.org/10.1136/annrheumdis-2013-204798
• Contract Date: Jun 15, 2016