Woman in bed rubbing her eyesTreat-to-target (T2T) approaches, which set specific remission or low disease activity goals, have been shown to benefit rheumatoid arthritis patients. But improvement in disease doesn’t necessarily correspond to a reduction in pain and fatigue, and patients tend to weigh the latter when they consider whether their health has improved, according to new research published in Arthritis Care & Research.

“Clinical improvements do not equate with improved subjective health for all patients,” the Dutch researchers write. “The associations of non-improvement with changes in pain and fatigue suggests that it might be worthwhile to monitor and address pain and fatigue in addition to and independently of disease activity in early rheumatoid arthritis.”

[Learn what pain looks like.]

Evidence has accumulated that treat-to-target — wherein “medication adjustments are made until predefined disease activity targets (usually remission or low disease activity) are reached” — results in better clinical outcomes than other treatments, the authors write. But prior studies demonstrated that patients can perceive their health statuses in ways that don’t correspond to inflammatory diseases activity.

“Little is known about the extent to which favorable clinical outcomes associated with T2T translate into improved subjective health status,” the authors write.

The study examined the “discordance” between favorable clinical results after a year of treat-to-target approaches and the health improvements that the 210 early RA patients self-reported. The 210, who experienced moderate to good responses, were culled from 259 patients in a cohort from Dutch Rheumatoid Arthritis Monitoring (DREAM). Their progress was measured in “disease activity, health related quality of life, physical functioning, pain, fatigue, joint stiffness, and laboratory measures,” the authors note.

[Read about tiredness, exhaustion, and fatigue.]

Although 75 (36 percent) patients had achieved “objective” moderate or good response, they didn’t think that their health had improved over 12 months. The researchers called that group, which relied on “subjective” measures, “non-improvers.” There were similar characteristics between “improvers” and “non-improvers,” although the latter reported morning stiffness at higher rates.