Patient Centricity: Can PROMs Fill the Gap between the Physician Perspective and the Dynamic Pattern of Patient Perceived Remission in Rheumatoid Arthritis

Objective: 1. Identify whether there is a discordance on comparing the patient versus the rheumatologist perspective on remission in RA; and, 2. Determine, from the patient perspective, the relation of patient reported outcomes to the most prevalent specific disease aspects reported in RA patients who achieved remission. Methods: Early RA patients diagnosed according to ACR/EULAR criteria were treated according a treat-to-target regime with regular disease activity monitoring. Remission was measured as: 1) patient perceived-; and 2) Physician perceived-remission. The study included 188 RA patients and 87 rheumatologists. All participants were asked to complete a survey composed of all domains identified in relation to the disease remission. 10 cm visual analogue scale was used to illustrate the importance of each domain. Results: The top 4 domains reported in the patients’ cohort who achieved remission were: pain (76%), functional ability (71%), quality of life (69%) and fatigue (43%), whereas the top 4 in the rheumatologist cohort were: low disease activity score (88%), radiologic remission and progression of erosions (76%), lab measures (ESR, CRP) (57%) followed by work difficulties (49%). There was a dynamic pattern of the most important domains reported when patients are stratified according to age, disease duration, comorbidity and motivation. Conclusion: Different factors are important for rheumatologists and RA patients regarding disease remission. Treatment satisfaction is determined not only by disease activity indices but also by other patient-oriented factors. PROMs could optimise targeted therapy as it can play a significant role in identifying disease activity parameters relevant to both the treating rheumatologist as well as the patient. Keywords: Discordance; PROMs; Rheumatoid arthritis; Patient perceived remission; Physician perceived remissio