Ab0954 When Patients in Remission Feel Not to Be in Remission – A Qualitative Study on Patients With Rheumatoid and Psoriatic Arthritis

Background: The assessment of patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) is challenging due to incorporation of multiple objective and subjective parameters. The assessment of disease activity of patients and physicians can be discordant leading to patient dissatisfaction regarding treatment decisions, poor adherence as well as adverse long-term outcomes. Objectives: To investigate the perspectives and experiences of PsA and RA patients considered to be in remission by joint counts and physician's global assessment (PhGA), but active disease according to patients' global assessment (PGA). Methods: Patients with a diagnosis of PsA based on the CASPAR criteria and patients with a diagnosis of RA fulfilling the 2010 ACR/EULAR classification criteria were asked to participate in this qualitative study, if the tender and swollen joint count was 0-1, physician global assessment was ≤10mm and patient global assessment was ≥25mm higher than physicians' global assessment. Patients' perspectives were collected within semi-structured, focus-group interviews in 2 centres in Austria and 1 centre in Italy. A semi-structured interview guide with open-ended questions was developed to explore factors that contribute to the patient-physician discordance. Patients were asked how they judge their own disease activity and which parameters influence their assessment. Another question was how they explain the difference between PGA and PhGA. Interview data were analysed by using an inductive thematic analysis. Results: We performed nine focus-groups with a total of 37 patients (17 RA and 20 PsA). Twenty patients (54.1%) were female with a mean age (±SD) of 61.2±14.4 and a mean disease duration of 7.2±7.1 years. We identified three main concepts that influenced the PGA: (1) pain, (2) mobility of joints and (3) restrictions in daily life. Patients described that the main factor to assess the disease activity from their view was the extent of pain and current mobility of joints (regardless if the reason of pain was inflammation or something else). Patients explained that physicians consider only objective parameters (mainly lab results and ultrasound) for disease activity assessment while the most important factor for patients is the presence of pain and its contribution to the restrictions in daily life. The results of the interviews revealed no difference in the concepts on how PsA or RA patients judge their assessment of disease activity. Conclusion: Joint pain and restricted joint mobility irrespective of inflammation are the most important factors for patients reflecting their disease activity. These contribute to the failure of the achievement of remission even though objective parameters of inflammation are negative. These results should help to better understand the reasons for remission failures and lead to a better shared-decision process. REFERENCES: NIL. Acknowledgements: This study was supported by a grant of the Austrian Society of Rheumatology. Disclosure of Interests: Angelika Lackner: None declared, Christina Duftner: None declared, Rusmir Husic: None declared, Martin Stradner: None declared, Jens Thiel Novartis, GSK, Bristol-Myers-Squibb, Astra-Zeneca, Abbvie, Galapagos, Vifor, Lilly, UCB and Janssen, Novartis, GSK, Bristol-Myers-Squibb, Astra-Zeneca, Abbvie, Galapagos, Vifor, Lilly, UCB and Janssen, GSK and Bristol Myers Squibb, Christian Dejaco Abbvie, Eli Lilly, Janssen, Galapagos, Novartis, Pfizer, Sparrow, Roche and Sanofi, Abbvie, Eli Lilly, Janssen, Galapagos, Novartis, Pfizer, Sparrow, Roche and Sanofi, Abbvie.