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BACKGROUND: Rheumatoid arthritis (RA) is a chronic disease that affects different areas of the patient's body. Patient education and health literacy is essential for them to participate actively in follow-up. OBJECTIVES: The aim of this study was to assess differences between clinimetric measurements done by a medical team and patient-reported outcome measures (PROMs) in RA and understand the impact of patient education strategies in order to identify differences between RA assessment methods. METHODS: This is a longitudinal cohort study. It included adult patients with RA and access to digital tools. These were divided into 3 groups by type of education. Group 1 included patients who participated in a multicomponent RA educational program. Group 2 did not have this multicomponent RA education. Group 3 did not receive any education. The 3 groups performed PROMs. Disease activity scales, functional class, and quality of life were measured. Univariate and bivariate analysis (χ2 and Wilcoxon for paired data) were done. RESULTS: Twenty-eight patients were included in group 1, 26 in group 2, and 37 in group 3. All were women. In group 1, there were no significant differences in clinimetrics between the medical team and patient's PROMs except for fatigue. In group 2 and group 3, significant differences were found. The RAPID3 and PAS variables did not show significant differences when analyzed by intervention subgroups. CONCLUSIONS: This study shows no differences between clinimetrics/PROMs for patients with a high-level education on RA and physicians. On the other hand, when patient did not have any RA education, the clinimetric results differed from physician measurement.
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Introduction: Rheumatoid arthritis is a chronic inflammatory disease diagnosed in a productive stage of life. Patients with RA experience changes in their musculoskeletal system, overall health and quality of life. It has been identified that patients with RA do not have appropriate knowledge about their condition. Educational programs can provide new knowledge, accompaniment, and closer follow-up to improve empowerment and quality of life in patients with RA. Purpose: To describe rheumatoid arthritis patients' experiences, perceptions, and expectations when enrolling on a multicomponent educational program in a specialized RA setting. Patients and Methods: A qualitative study was done. Patients with RA who attended a specialized center and enrolled in an educational program participated in two focus groups. The focus group discussions and the interviews were recorded, transcribed verbatim, analyzed, and emerging themes were constructed. Results: Thirty-one participants were included in the focus groups. The median age was 60 years IQR (54-67), 92% were female. Two relevant categories emerged: first, the experience of being diagnosed with RA. Second, the program's ability to empower participants with knowledge and the possibility of transferring knowledge to other patients with the same condition. In addition, patients gave a high score to the expectations regarding the educational program. Conclusion: Understanding patients' expectations when enrolling in an educational program allows educators and clinicians to understand their motivations to create tailored programs that can contribute to acquiring empowerment in the educational process and managing their disease. Stakeholders should consider patients' expectations when implementing these interventions for patients with RA to adapt the intervention according to the patient's context and needs, which will directly affect the patient's adherence and lead to better use and allocation of resources for educational activities.
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Purpose: Tofacitinib is recommended for treatment of rheumatoid arthritis (RA) in patients with moderate to severe disease activity, but there is not enough evidence on its effectiveness after conventional DMARDs vs its use after biologics. The aim was evaluating the effectiveness of tofacitinib in RA as first-line treatment (after conventional DMARDs) in a real-life setting in Colombian (Latin-American) patients. Patients and Methods: Retrospective cohort study conducted at a specialized center for RA management. A complete statistical analysis was performed to compare the values of the change in the DAS28 at months 3, 6, and 12 in both treatment groups. Results: A total of 152 RA patients who received tofacitinib: first-line 85 patients (55.9%) after failure on conventional DMARDs or second-line 67 patients (44.1%) after failure on biologic DMARDs. Comparative analysis of response to treatment showed a reduction in DAS28 at 3, 6, and 12 months in both study groups without statistical differences, but a higher proportion of first-line patients achieved remission (45% vs 23%). Nonresponse at three months were associated with no response at six months of follow-up. Baseline DAS28 was significantly associated with response at 12 months (OR: 1.87, 95%CI: 1.06-3.30, p-value 0.028). In second-line patients, response to tofacitinib was not related to number of biologic DMARDs previously used. Conclusion: Tofacitinib is an effective treatment option for patients with RA, maybe better after conventional DMARDs than after biologic therapy failure. Further studies are required to determine the role of tofacitinib in different lines of RA treatment and in other groups of patients.