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“There is something you must see”: breaking down the remission concept in rheumatoid arthritis from a rheumatologist's perspective

1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23

  1. Rheumatology, Hospital General de Villalba, Madrid, Spain.
  2. Department of Rheumatology, Hospital Universitario Puerta de Hierro, Madrid, Spain.
  3. Department of Rheumatology, Hospital Universitario La Paz, Madrid, Spain.
  4. Department of Rheumatology, Hospital Universitario de Sant Joan d’Alacant, Alicante, Spain.
  5. Department of Rheumatology, Complexo Hospitalario Universitario A Coruña, Spain.
  6. Rheumatology, Hospital de Galdacano, Bilbao, Spain.
  7. Department of Rheumatology, Hospital Clinic de Barcelona, Spain.
  8. Department of Rheumatology, Hospital Clínico San Carlos, Madrid, Spain.
  9. Rheumatology, Hospital Universitario de Salamanca, Spain.
  10. Department of Rheumatology, Hospital Universitario de Valme, Sevilla, Spain.
  11. Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
  12. Rheumatology, Hospital Universitario de Bellvitge, Barcelona, Spain.
  13. Rheumatology, Hospital Universitario de la Princesa, Madrid, Spain.
  14. Rheumatology, Instituto de Investigación Hospital 12 de Octubre; Universidad Complutense, Madrid, Spain.
  15. Rheumatology, Hospital Universitario de León, Spain.
  16. Rheumatology, Hospital Universitario de Gran Canaria Dr Negrin, Las Palmas, Spain.
  17. Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
  18. Hospital Universitario de Mostoles, Madrid, Spain.
  19. Instituto de Salud Musculoesquelética, Madrid, Spain.
  20. Instituto de Salud Musculoesquelética, Madrid, Spain.
  21. Instituto de Salud Musculoesquelética, Madrid, Spain.
  22. Pfizer, Medical Department, Madrid, Spain.
  23. Pfizer, Medical Department, Madrid, Spain. maria.montoro@pfizer.com

CER11952 Submission on line
Full Papers

Rheumatology Article
Rheumatology Article

 

Abstract

OBJECTIVES. To explore the remission concept in rheumatoid arthritis (RA) and the implications of the existing definitions when applied to clinical practice among rheumatologists with different profiles.
METHODS:
A qualitative study through focus groups was conducted. Three focus groups were organised from February to March 2016. Each group was composed of rheumatologists with extensive clinical experience with different profiles; experts in basic research (RBR), experts in imaging techniques research (RIR), and experts in clinical research (RCR). The data was collected with audio recording. Verbatim transcriptions of the audio files were made, and a subsequent reflexive thematic analysis assisted by ATLAS.ti (GmbH, Berlin, v. 7) software was performed.
RESULTS:
From the reflexive thematic analysis, three main themes were generated: (1) remission limitations, (2) instruments or measures to assess remission, and (3) a new definition of remission. Rheumatologists mentioned frequently that the following variables should be considered when developing a new remission definition: inflammatory activity, calprotectin, psychological variables, sex, disease stage, and sociocultural factors. Contrary to what could be expected, all groups acknowledged that their research field could contribute with domains for a gold standard remission instrument, but not in a hierarchical arrangement of importance. The dissonance existing in the entire remission evaluation process was outlined: remission in clinical practice versus remission in clinical trials, remission following the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) Boolean versus Musculoskeletal Ultrasound (US) remission, and remission from the rheumatologist’s point of view versus the patient’s point of view.
CONCLUSIONS:
Currently, rheumatologists would not accept a domain as more important than others in remission. Our suggestion is, not to generate a universal definition of remission – one that could cover all aspects – but rather to develop definitions of remission for the different settings that could be pondered by the patient’s perspective.

PMID: 31573477 [PubMed]

Received: 28/11/2018 - Accepted : 26/03/2019 - In Press: 18/09/2019