Functional capacity vs side effects: treatment attributes to consider when individualising treatment for patients with rheumatoid arthritis

Karin Schölin Bywall,Marta Lason,Inger Erlandsson,Bente Appel Esbensen,Marie Heidenvall,Jennifer Viberg Johansson

doi:10.1007/s10067-021-05961-8

Abstract

IntroductionIndividualisation of rheumatoid arthritis (RA) treatment needs to take account of individual patients’ preferences to increase patient-centeredness in treatment decisions. The aim of this study was to identify patient-relevant treatment attributes to consider when individualising treatment for patients with RA.MethodPatients with RA in Sweden were invited to rank the most important treatment attributes in an online survey (April to May 2020). Semi-structured interviews were conducted (October to November 2020) to further identify and frame potential attributes for shared decision-making. The interviews were audio-recorded, transcribed and analysed using thematic framework analysis. Patient research partners and rheumatologists supported the selection and framing of the treatment attributes across the assessment.ResultsThe highest ranked attributes (N = 184) were improved functional capacity, reduced inflammation, reduced pain and fatigue and the risk of getting a severe side effect. The framework analysis revealed two overarching themes for further exploration: treatment goals and side effects. ‘Treatment goals’ emerged from functional capacity, revealing two dimensions: physical functional capacity and psychosocial functional capacity. ‘Side effects’ revealed that mild and severe side effects were the most important to discuss in shared decision-making.ConclusionsFunctional capacity (physical and psychosocial) and potential side effects (mild and severe) are important treatment attributes to consider when individualising RA treatment. Future research should assess how patients with RA weigh benefits and risks against each other, in order to increase patient-centeredness early on the treatment trajectory.Key Points• It is essential for the individualisation of treatment to identify what attributes patients with RA are willing to trade off in order to increase patient-centeredness in precision care.• Individualisation of rheumatoid arthritis treatment needs to account for patients’ preferences on functional capacity and side effects.• Future research is needed to assess how patients with rheumatoid arthritis weigh functional capacity against side effects, in order to increase patient-centeredness in treatment decisions.

Highlights

Individualisation of rheumatoid arthritis (RA) treatment needs to take account of individual patients’ preferences to increase patient-centeredness in treatment decisions
Five of the attributes related to potential side effects: ‘to avoid mild short-term side effects such as nausea and headache’; ‘to avoid damage in the long term such as arteriosclerosis or osteoporosis’; ‘to avoid severe side effects such as infections leading to me being hospitalised’; ‘to avoid side effects that can affect my mental health, such as mood changes or sleep disturbance’; and ‘to avoid side effects that can alter the way I look, such as skin rash or weight change’
The results of this study suggested that attributes serving to support patients in treatment individualisation need to reflect patients’ own treatment goals and preferences rather than taking a clinical standpoint

Summary

Introduction

Individualisation of rheumatoid arthritis (RA) treatment needs to take account of individual patients’ preferences to increase patient-centeredness in treatment decisions. Conclusions Functional capacity (physical and psychosocial) and potential side effects (mild and severe) are important treatment attributes to consider when individualising RA treatment. Rheumatoid arthritis (RA) is one such condition: an inflammatory autoimmune disease, usually treated with disease-modifying antirheumatic drugs (DMARDs), which target joint inflammation in various different ways [1]. This creates differences that may affect patients’ daily life, for instance, in administration, effectiveness and side effects. Clinical Rheumatology response in RA has resulted in a trial-and-error approach to identifying the best treatment This can be both exhausting to patients and wasteful of healthcare resources. A more individualised treatment approach called ‘precision care’ attempts to find biomarkers through ‘omics’ to match patients with therapies which they are likely to respond to, using prediction algorithms [3]

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