"There is something you must see": breaking down the remission concept in rheumatoid arthritis from a rheumatologist's perspective
Por:
Acebes C, Andreu JL, Balsa A, Batlle E, de Toro-Santos J, García Llorente F, Hernández MV, Fernandez-Guiterrez B, Hidalgo-Calleja C, Mayordomo L, Naredo E, Narváez FJ, Ortiz AM, Pablos JL, Pérez-Sandoval T, Rodriguez-Lozano C, Sánchez-Pernaute O, Usón J, Negrón JB, Loza E, Carmona L, Gómez Castro S and Montoro Alvarez M
Publicada:
1 ene 2020
Ahead of Print:
18 sep 2019
Resumen:
Objective
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.
Conclusion
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.
Filiaciones:
Acebes C:
Rheumatology, Hospital General de Villalba, Madrid, Spain
Andreu JL:
Department of Rheumatology, Hospital Universitario Puerta de Hierro, Madrid, Spain
Balsa A:
Department of Rheumatology, Hospital Universitario La Paz, Madrid, Spain
Batlle E:
Department of Rheumatology, Hospital Universitario de Sant Joan d'Alacant, Alicante, Spain
de Toro-Santos J:
Department of Rheumatology, Complexo Hospitalario Universitario A Coruña, Spain
García Llorente F:
Rheumatology, Hospital de Galdacano, Bilbao, Spain
Hernández MV:
Department of Rheumatology, Hospital Clinic de Barcelona, Spain
Fernandez-Guiterrez B:
Department of Rheumatology, Hospital Clínico San Carlos, Madrid, Spain
Hidalgo-Calleja C:
Rheumatology, Hospital Universitario de Salamanca, Spain
Mayordomo L:
Department of Rheumatology, Hospital Universitario de Valme, Sevilla, Spain
Naredo E:
Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
Narváez FJ:
Rheumatology, Hospital Universitario de Bellvitge, Barcelona, Spain
Ortiz AM:
Rheumatology, Hospital Universitario de la Princesa, Madrid, Spain
Pablos JL:
Rheumatology, Instituto de Investigación Hospital 12 de Octubre
Universidad Complutense, Madrid, Spain
Pérez-Sandoval T:
Rheumatology, Hospital Universitario de León, Spain
Rodriguez-Lozano C:
Rheumatology, Hospital Universitario de Gran Canaria Dr Negrin, Las Palmas, Spain
Sánchez-Pernaute O:
Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
Usón J:
Hospital Universitario de Mostoles, Madrid, Spain
Negrón JB:
Instituto de Salud Musculoesquelética, Madrid, Spain
Loza E:
Instituto de Salud Musculoesquelética, Madrid, Spain
Carmona L:
Instituto de Salud Musculoesquelética, Madrid, Spain
Gómez Castro S:
Pfizer, Medical Department, Madrid, Spain
Montoro Alvarez M:
Pfizer, Medical Department, Madrid, Spain.
Open Access
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