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Study concludes that many patients with rheumatoid arthritis may be over-medicated

A significant proportion of patients with rheumatoid arthritis may be over-medicated due to poor self-assessment, the study concludes.

A very significant proportion of patients with rheumatoid arthritis, an inflammatory disease of the joints, may be over-medicated due to a poor self-assessment of their condition, concludes a study by a team led by José António Pereira da Silva, professor at the Faculty of Medicine of University of Coimbra (FMUC) and director of the Rheumatology Service of the Hospital and University Center of Coimbra (CHUC).

Since there is still no cure for rheumatoid arthritis, reaching the state of remission of the disease, that is, the complete absence of inflammatory activity is essential for patients and doctors. To define this state of remission, one of the indicators used in the clinic is the Global Patient Assessment (PtGA), reported by the patient about his condition. However, it is an indicator that depends on the patient’s interpretation and may affect treatment.

According to the international standards established for the treatment of rheumatoid arthritis, supported by the European and American rheumatology associations, the remission of the disease requires that there is no more than one painful or inflamed joint and that the overall assessment by the patient is at most 1, on an analog scale from zero to 10.

The researchers wanted to analyze the impact of the patient’s overall assessment on achieving remission status in patients with rheumatoid arthritis. To this end, a meta-analysis was carried out on eight national and international studies, reflecting clinical trials and contexts of current clinical practice, with data from 23297 patients.

The results obtained in this study allow us to conclude that the global assessment by the patient “is the main isolated cause of not reaching the remission state. In fact, evaluating the results of these studies, including two of our authorship, we concluded that 12% of the 23297 patients reached complete remission, while 19% failed only due to the global assessment reported by the patient”, reports José António Pereira da Silva.

Considering that, in previous studies, it had already been demonstrated that “the global assessment by the patient does not, in these circumstances, reflect the presence of persistent inflammation, but rather is related to concomitant diseases, pain of another origin and depressive states, these results indicate that a very significant part of patients with rheumatoid arthritis will be receiving excessive treatment if international recommendations are followed since the circumstance that prevents the therapeutic target from being reached is not amenable to improvement by treatment aimed at rheumatoid arthritis”, explains the professor FMUC.

In other words, he reinforces, “this global assessment of the disease by the patient inadequately prevents a high percentage of patients from reaching the therapeutic target of remission, thus placing them at risk of overtreatment”. According to established international guidelines, if remission is not achieved, treatment must be reinforced. This is justified because the remission corresponds to the best symptomatic result and also to the best guarantee of long-term preservation of the structural integrity of the joints and the functional capacity of the patient”.

This study, distinguished at the European Congress of Rheumatology 2020, which recently took place in an online format due to the current pandemic crisis, is part of “a movement with a strong international impact, led by the CHUC Rheumatology Service, in order to review the international definitions of remission and therapeutic target in this important clinical condition”, says José António Pereira da Silva.

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