Fears and Concerns: Comparing Patient and Physician Perspectives in Management of Rheumatoid Arthritis

According to what is reported by ISTAT (ISTAT 2017), in Italy among the most common chronic diseases or conditions, i.e. among the long-lasting and generally slow-progressing health problems, rheumatic diseases stood out in 2nd place (after hypertension) such as: osteoarthritis and arthritis (the latter for 15.9%).

Arthritis, in particular, belongs to the largest group of rheumatic diseases; a category of chronic conditions involving the musculoskeletal system.

The diagnosis of a chronic disease such as rheumatoid arthritis (RA) can trigger anxiety, fear and worry, involving not only the emotional sphere but also affecting the patient’s quality of life.

The importance of paying greater attention to increasing the quality of life of subjects with musculoskeletal disorders has been emphasized, in recent years, by the World Health Organization (WHO) itself [1]

This is also in light of the fact that the main symptoms of these diseases are fatigue and pain.

As they are not visible symptoms, they are often misrecognized or misinterpreted by other people and underestimated by health professionals.

Sometimes, in fact, there is a real gap between the more objective measures of disease severity (dictated for example by analyzes such as ultrasound and radiography) and what patients report about their pain and disability (Finan et al. ., 2013; Wolfe et al. 2014).

In 2018, the results of a patient-based and physician-based survey developed by the global advisory group RA NarRAtive (an initiative sponsored by Pfizer Inc.) were published in the BMC Journal.

The patient-based survey was conducted by Harris Poll in 16 countries from September 2014 to April 2016. [17-18]

In order to compare patient and physician survey results, patient survey results are reported only for respondents who currently see a rheumatologist.

Thus, the physician questionnaire mirrored the patient questionnaire, where possible, and physicians were asked to provide general information on all RA patients they were responsible for.

Of the 16 countries involved, 4170 RA patients responded to the survey, of which 1805 were mainly managed by a rheumatologist, and a total of 1736 physicians responded to the medical survey.

Reporting some data from the study, 94% of patients had concerns about their RA; in particular, these concerns related to treatment problems, including symptoms, treatment failure, exhaustion of treatment options, and exacerbations following drug modification.

The importance of these topics was considered similar by doctors.

Regarding patient-doctor communication: 61% of patients felt uncomfortable raising concerns or fears with their doctor. When asked to give reasons for this, 32% felt their doctor knew and should have followed what their doctor had told them, and the remainder were concerned that their doctor. considering a patient as difficult and what could affect the quality of care received.

On the medical side, most (90%) of respondents were satisfied with communications with their patients regarding RA treatment. However, 68% wanted them and their patients to talk more about their RA goals and treatment, and 66% wished they could see their patients more often.

Patient-reported goals for RA management were similar to clinicians reported goals based on their discussions; with pain relief as the main option.

However, some of the goals were viewed differently by patients and doctors. For example, the reduction of further joint damage and fatigue were considered of greater relative importance in the patient survey than in the medical survey, in contrast, prevention, remission of RA and the ability to resume work were considered. of greater importance in the physician investigation than the patient survey.

In conclusion, although patients and doctors attached similar importance to communication, the survey results highlighted important disconnections between patients and doctors, for example, regarding the importance of returning to work as a treatment goal.

The findings suggest that overall, greater understanding and awareness of discrepancies in patient and physician experiences could foster better patient communication and engagement and possibly lead to better patient adherence and overall satisfaction.

Based on this evidence, iCareX is committed to making rheumatoid arthritis a manageable disease. The exploRA Test, in this case, represents the product that supports the doctor and the patient to learn more about the disease and to face the therapeutic path together by making more suitable and accurate decisions for the patient.




  1. (Franco-Aguirre, Cardona-Tapias, & Cardona-Arias, 2017).


  1. Dikranian A, Galloway J, Kekow J, Mannica A, Spurden D, Bananis E, et al. Understanding the importance of a patient’s role in the management of RA: results from a patient-based survey. [abstract]. Arthritis Rheumatol. 2015; 67: 2324.


  1. Koehn C, Dikranian A, Maniccia A, Bananis E. Understanding the importance of a patient’s role in the management of RA: results from a patient-based survey developed by the RA Narrative Global Advisory Panel [abstract]. Ann Rheum Dis. 2016; 75: 152.


  1. Fleischmann R, Strand V, Wilkinson B, Kwok K, Bananis E. Relationship between clinical and patient-reported outcomes in a phase 3 trial of tofacitinib or MTX in MTX-naïve patients with rheumatoid arthritis. RMD Open. 2016; 2: e000232.


     27 Strand V, Kavanaugh A, Kivitz AJ, van der Heijde D, Hoffmann E, Akylbekova E, et al. Long-term radiographic and patient-              reported outcomes based on Clinical Disease Activity Index responses with tofacitinib at 6 months [abstract]. Arthritis Rheumatol. 2015; 67: 1633.

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