Is the role of medical consultation in rheumatoid arthritis a timely topic?

Background: Despite the treat-to-target recommendations and the efforts in dissecting factors that contribute to achieving disease control, the goal of remission in rheumatoid arthritis (RA) is accomplished in less than half of patients. Disease activity is assessed using composite indexes which are reliant on patient-reported outcomes, mainly the patient global assessment of disease activity (PGA). The debate on variables that can influence PGA is still open, and different internal and external factors had been taken into account: the origin of pain symptoms, psychosocial and lifestyle factors. Objectives: To canvass the opinion of RA Italian patients concerning patient-perceived topics that matter most for future research. Methods: A cross-sectional no-profit on-line anonymous survey was devised to evaluate opinions of the rheumatic diseases patients. In this sub-study we focused only on the data about RA patients. Patients were asked to rate the following topics: food/nutrition, air pollution, smoking, type of work, social participation, physical activity, emotional well-being/stress, alternative medicine, patient-physician relationship. Moreover, patients were inquired about why the topic was considered important (disease prevention, stop disease progression, control symptoms, cure the disease). The survey was disseminated between June and October 2019. Descriptive statistics were used to summarize the patient demographic, clinical data and survey results. Results: 94% (82/87) of RA patients (81 female, median age 50 yrs) rated the patient-physician relationship as the main topic for future research (figure below). Likewise, intriguing results came from the reasons of previous patient rating: the patient-physician relationship was considered important for a better control of RA symptoms (48.8%), to cure the disease (30.5%), to stop disease progression (19.5%), and to prevent the disease (1.2%). These results were similar in all age groups. Conclusion: These results highlight that the importance of medical consultation to patients and its impact on disease control should not be under-estimated. Administrative duties, time and economic constraints undermine the patient-physician relationship that is central to clinical care. The limited time spent for medical consultation is directly related to patient dissatisfaction, which in turn, may influence the patient’s perception about the absence of disease activity and could be one of motives behind the worse evaluation of PGA. Acknowledgments: We wish to thank the Lombard Association of Rheumatic Diseases (ALOMAR), Maria Vittoria Ausilio and Patrizia Angiolillo from the IT service of the University of Milan.