Understanding Heterogeneity in Patients' Conceptualisation of Treatment for Rheumatoid Arthritis: A Cluster Analysis

Area of Science:

• Rheumatology
• Patient-reported outcomes
• Health services research

Background:

• Uptake of treat-to-target (TTT) strategies for rheumatoid arthritis (RA) management remains suboptimal.
• Understanding patient perspectives on RA treatment is crucial for improving adherence to TTT strategies.

Purpose of the Study:

• To investigate the heterogeneity in how patients conceptualize rheumatoid arthritis treatment.
• To identify factors influencing patient adherence to TTT strategies for RA.

Main Methods:

• Principal components analysis was used on patient-rated items to identify key concepts in RA treatment conceptualization.
• Regression analysis identified factors predicting medication adherence beyond demographic characteristics.
• 621 individuals with RA participated, rating 56 items on 5-point scales.

Main Results:

• Significant heterogeneity was found in patients' conceptualization of RA treatment.
• Four factors emerged: access to care, low decisional conflict regarding DMARD changes, favorable DMARD risk/benefit perception, and confidence in disease activity testing.
• These factors explained 13.8% of medication adherence variance, with patient-physician communication quality being a key predictor of poor adherence.

Conclusions:

• Patient conceptualization of RA treatment is diverse, with challenges in escalating disease-modifying antirheumatic drugs (DMARDs) despite understanding TTT benefits.
• Tailored interventions are necessary to address patient hesitancy in DMARD escalation and improve TTT uptake.