title: The patient perspective on remission in rheumatoid arthritis: 'You've got limits, but you're back to being you again'.
abstract: OBJECTIVE
  The aim of rheumatoid arthritis (RA) treatment is remission. As treatment should be targeted at outcomes relevant to patients, it is important to understand how patients perceive remission, and to assess whether the current definition of remission adequately reflects these perceptions. The objective of this study is to explore the patient perspective on remission in RA.
  
  
  METHODS
  Nine focus-group discussions in Austria, The Netherlands and UK were conducted, including patients in American College of Rheumatology (ACR)/ European League of Rheumatology (EULAR) remission, self-declared remission and in moderate/high disease activity. Moderators employed a prespecified interview guide helped to engage patients in a discussion on their experience with remission. Inductive thematic analysis was performed within each country, and identified themes were discussed across countries.
  
  
  RESULTS
  47 RA patients (66% women, disease duration 9 years) participated. Three major themes of patient-perceived remission emerged: (1) symptoms would either be absent or strongly reduced, (2) impact of the disease on daily life would diminish by increased independence, ability to do valued activities, improved mood and ability to cope; (3) leading to a return to normality, including work, family role and perception of others. Patients felt the concept of remission was influenced by ageing, side effects of medication, comorbidities, accrued damage to joints and disease duration. Opinions on duration of state, the role of medication and measurement instruments varied widely.
  
  
  CONCLUSIONS
  Patients characterise remission by the absence or reduction of symptoms, but more directly by decreased daily impact of their condition and the feeling of a return to normality. The next step is to study whether an additional patient-perceived measure of remission may add value to the ACR/EULAR definition of remission.
authors: Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands.
authors: Lilian H D
authors: LH
authors: van Tuyl
authors: Nursing and Midwifery, University of the West of England, Bristol, UK.
authors: Sarah
authors: S
authors: Hewlett
authors: Division of Rheumatology, Department of Medicine, Medical University of Vienna, Vienna, Austria.
authors: Martina
authors: M
authors: Sadlonova
authors: Bristol Royal Infirmary, Bristol, UK.
authors: Bev
authors: B
authors: Davis
authors: Nursing and Midwifery, University of the West of England, Bristol, UK.
authors: Caroline
authors: C
authors: Flurey
authors: Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands.
authors: Wijnanda
authors: W
authors: Hoogland
authors: Academic Rheumatology Unit, University of Bristol, Bristol, UK.
authors: John
authors: J
authors: Kirwan
authors: Nursing and Midwifery, University of the West of England, Bristol, UK.
authors: Tessa
authors: T
authors: Sanderson
authors: Jan van Breemen Research Institute | Reade, Amsterdam, The Netherlands.
authors: Dirkjan
authors: D
authors: van Schaardenburg
authors: Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands.
authors: Marieke
authors: M
authors: Scholte-Voshaar
authors: Division of Rheumatology, Department of Medicine, Medical University of Vienna, Vienna, Austria.
authors: Josef
authors: J
authors: Smolen
authors: Division of Rheumatology, Department of Medicine, Medical University of Vienna, Vienna, Austria.
authors: Tanja
authors: T
authors: Stamm
authors: Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.
authors: Maarten
authors: M
authors: Boers
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000523:psychology*; D001294:Attitude to Health; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D012074:Remission Induction; D062707:Return to Work; D012720:Severity of Illness Index
keywords: Outcomes Research; Patient Perspective; Qualitative Research; Rheumatoid Arthritis