Changes in priorities for improvement in patients with rheumatoid arthritis during 1 year of anti-tumour necrosis factor treatment

Objectives: To examine priorities for health status improvement in patients with active rheumatoid arthritis ( RA) during anti- tumour necrosis factor ( TNF) treatment. Methods: Data were used from 173 patients with RA starting treatment with TNF- blocking agents. Outcome measures included assessment of health status with the Arthritis Impact Measurement Scales 2 ( AIMS2) at baseline and after 3 and 12 months. The AIMS2 contains a priority list from which patients are asked to select from 12 areas of health the 3 in which they would most like to see improvement. Results: After 1 year of treatment, 10 out of 12 areas of health on the AIMS2 were significantly improved. The most commonly selected priorities for improvement at baseline were pain ( 88%), hand and finger function ( 57%), walking and bending ( 42%), mobility ( 33%), and work ( 29%). At group level, this priority ranking remained largely unchanged during treatment. After adjustment for multiple comparisons, only pain was selected significantly less often at 3 and 12 months ( 71% at both assessments). Within individual patients, however, priorities often changed. Changes in the priority of pain were related to the achieved level of patient- perceived pain and disease activity. Conclusions: This study shows that, at the group level, patients' priorities for improvement are fairly stable during 12 months of anti- TNF therapy, despite major improvements in health status. Although pain reduction becomes somewhat less important, it remains the most commonly selected priority. In contrast, individual patient priorities are not stable over the course of treatment and appear to be associated with differences in disease state.