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While the goal of rheumatoid arthritis treatment is low disease activity and remission, many patients are apprehensive about changing or escalating RA treatment.
A novel, patient-directed, video-based intervention, focused on treatment changes and escalation, improved a patient’s inclination to change treatment if and when suggested by their rheumatologist, according to a study published in Open Rheumatology.1
“To maximize long-term health-related quality of life and prevent structural damage in affected joints in patients with rheumatoid arthritis (RA), current guidelines recommend that the goal of RA treatment is to achieve remission or low disease activity,” investigators explained. “Despite the availability and efficacy of many treatment options, fewer than half of patients with RA with moderate/high disease activity enrolled in a United States physician-based registry received treatment escalation.”
CONTROL-RA was a controlled, randomized trial that utilized the ArthritisPower registry, which contains information on over 27000 patients with rheumatic diseases, to assess participants’ current disease activity and disease control, as well as their beliefs regarding RA medication, modifying their treatment plan, and any decisional conflicts. A baseline survey included questions about general health, health literacy, and whether the goals of RA treatment were recently discussed with a rheumatologist. Eligible patients were aged 19 years or older and had a clinical diagnosis of RA.
Participants in the intervention cohort viewed educational videos, including information about the treat-to-target (T2T) strategy, while the control group watched vaccination-related videos. The intervention video program highlighted the benefits of a T2T approach and addressed patient-reported concerns, such as worsening symptoms and medication side effects that may occur during escalations in treatment. Those in the control group watched 2 videos: “Living with RA: why get vaccinated?” and “Living with RA: which vaccines should I get?”
Two subsequent follow-up surveys were performed: one immediately after viewing the videos and one after a clinical visit with their rheumatologist. Patients’ willingness to modify treatment and decisional conflict was analyzed and compared between both groups.
A total of 208 patients completed the post-video follow-up survey, of which 90% were White, 90% were women, and the mean age was 50 years. Of these patients, 64% (n = 132) completed the second follow-up questionnaire. Approximately half (52%) were familiar with the RA T2T approach, although most had discussed treatment goals and disease activity with their rheumatologist.
Those in the intervention group were much more likely to accept treatment changes when compared with the control group (0.49 [95% confidence interval 0.09-0.88], P = 0.02). There was a significantly higher willingness to alter treatment within the subgroup of participants who were unfamiliar with T2T (50 patients in each arm) in the intervention group when compared with the control group (0.52 [95% CI 0.001-1.04], P = 0.049).
While decisional conflict decreased in both groups, differences were not significant.
A lack of generalizability, due to the similar demographics of the patient population, limited the study. While patients in the intervention arm were more likely to change RA treatment if needed, investigates did not collect disease activity measures, and were therefore unable to determine whether these patients were more likely to achieve remission or low disease activity when compared with the controls. Future studies should address this concern.
“Educational interventions, such as the one we developed and tested, could be part of behavioral intervention programs that include counselling about shared decision-making on RA management,” investigators concluded. “Further studies are needed to evaluate whether this change in patients’ willingness translates into actual behavior modification, namely, RA treatment escalation at the appropriate time.”
Danila MI, Chen L, Ruderman EM, et al. Evaluation of an Intervention to Support Patient-Rheumatologist Conversations About Escalating Treatment in Patients with Rheumatoid Arthritis: A Proof-of-Principle Study [published online ahead of print, 2021 Dec 27]. ACR Open Rheumatol. 2021;10.1002/acr2.11393. doi:10.1002/acr2.11393