Dissonance between physicians’ and patients’ perspectives on managing impaired morning function in Asian patients with rheumatoid arthritis

Abstract

Abstract Objectives To estimate the prevalence of impaired morning function (IMF) in rheumatoid arthritis (RA), and to understand physicians’ and patients’ perceptions on the impact of IMF and treatment in selected Asian countries. Methods A survey on the impact of IMF was conducted in Asia on rheumatologists and patients with moderate-to-severe RA who experienced IMF for ≥3 mornings a week. Participants underwent comprehensive face-to-face interviews using structured questionnaires. Results Sixty physicians and 300 patients from Hong Kong, Philippines, Singapore, South Korea, and Taiwan were surveyed. Rheumatologists estimated that two-thirds of patients with RA experienced IMF and believed that the prevalence of IMF increased with RA severity (present in 42%, 73%, and 87% of patients with mild, moderate, and severe disease, respectively). Patients’ survey revealed that, on an average, patients with RA experienced IMF 5 days a week for 2 h each day. Thirty-eight percent of patients with RA considered a reduction in morning stiffness as an important treatment goal, but this was agreed by only 3% of rheumatologists. Only 22% of rheumatologists modified the treatment regimen specifically for IMF. Physicians considered prednisolone and other glucocorticoids (GCs) to be the most effective medication for the treatment of IMF. Fifty-one percent of patients with RA did not find their current medication effective in relieving IMF, and as a result, they reported negative emotions such as frustration, defeat, and anger, and 56% had missed work because of this symptom. Conclusions IMF is prevalent in RA and significantly affects patients’ quality of life (QoL). A higher proportion of patients compared to physicians view the reduction of morning stiffness as an important goal. More should be done to address the dissonance between physicians’ and patients’ views on IMF.