Metacognition in Rheumatoid Arthritis: Thinking About Our Thinking in Rheumatoid Arthritis Management

Abstract

Metacognition is thinking about thinking, knowing about knowing, and being aware of your own awareness. It refers to the processes used to plan, monitor, and assess our own understanding and performance. By applying this metacognition concept and thinking critically about current beliefs and practices in the management of rheumatoid arthritis (RA), this symposium aimed to help rheumatologists think about how to positively impact patient care. Prof Andrea Rubbert-Roth introduced the meeting by looking at current approaches to the management and treatment of RA and the disconnect between the treatment goals of physicians and patients. Prof John Weinman provided an overview of the causes and extent of non-adherence, focussing on the role of patient beliefs and the use of consultations to facilitate better adherence. In the third presentation, Prof Daniel Aletaha applied the concept of ‘the ideal’ versus ‘the norm’ to three important areas in the management of RA: how we define remission, how we measure remission, and the minimally clinically important difference (MCID) in treatment outcomes as perceived by the patient. Prof Rubbert-Roth followed up with a review of the data on cycling or switching between different classes of biologic treatment and the use of patient characteristics and, eventually, biomarkers to guide the preference of clinicians for drugs targeting tumour necrosis factor (TNF) or other targets with overlapping but distinct signalling pathways, such as IL-6. Finally, Prof Weinman discussed the holistic care and treatment of patients with RA, emphasising the need for an empathic and collaborative approach to patient care.