A Physician’s Perspective: Partnering with RA Patients for Better Outcomes

Those readers who are following our Vectra Voice regularly know that we are in the middle of a series sharing what happened during our Patient Ambassador meeting in Tampa (learn how we kicked off Arthritis Awareness Month here).

Dr. Susan ZitoDr. Susan Zito, a rheumatologist based in Largo, Florida, a rheumatologist based in Largo, Florida, joined our Ambassadors to share her perspective on RA, encouraging RA patients to advocate for themselves, to help educate their physicians and to hold their doctors to high standards. As medical knowledge about RA continues to advance, individual physicians, regulatory bodies, and third-party payers all impact the way that RA patients get care.

Beginning by reviewing some of the science behind RA, Dr. Zito also spoke about the importance of early diagnosis. In 2015, the American College of Rheumatology re-issued guidelines for the treatment of RA including recommendations for the treatment of patients with early RA. “It’s good when other doctors are asking if you really have RA,” said Dr. Zito, “because that means it’s been caught early and your treatment is working.”

Many of our readers know that RA can affect not only the joints but also the organs, even resulting in nodules in the skin. As science uncovers more about RA, doctors are learning about sub-types of RA based upon different biomarkers.

As science continues to advance, however, RA patients often are impacted by parts of the health care system that haven’t always kept pace. For example, radiographic progression is a standard by which potential new therapies are evaluated. However, erosions are visible via radiography at the centimeter level. “The presence of erosions can mean the early window for intervention has been lost,” said Dr. Zito. She recommended that doctors include the use of ultrasound and MRI, which are able to measure bone erosion at the millimeter level.

“The goal should be to see that things are correcting,” said Dr. Zito. “Even bone erosions of 5 millimeters can be healed with some therapies. MRI, ultrasound and Vectra can all be used as intermediate determiners to confirm that the subjective evidence, such as swelling and pain, is tracking with objective evidence.”

Dr. Zito also spoke about available therapies, situations in which certain therapies make sense for certain periods of time and the hope offered in knowing that new medicines are becoming available each year.

“We aren’t sure why RA happens although certain triggers have been identified,” she continued. “When a patient’s therapy stops working, it’s important to see if any triggers are at play. Sometimes it’s that the patient is experiencing increased stress in their lives. Doctors can talk with patients about getting through a specific period of time with additional or different treatments until that stress is no longer present.”

Dr. Susan Zito discussing RADr. Zito spoke of the challenges presented when insurers require that a patient follow a specific path of trying and failing certain treatments before allowing access to another treatment. She encouraged the Ambassadors to push to try different therapies if their current therapy isn’t working and to partner with their doctors by providing evidence when insurance-mandated therapies don’t work.

She also encouraged patients to hold doctors to high standards. “The words, ‘I’m doing great,’ spoken by a patient shouldn’t translate into not needing to evaluate whether therapy is working,” noted Dr. Zito. “Even when a patient is feeling good, there’s a need for objective evidence. Progression of disease is ‘doing harm’ to patients, and a patient should expect their physician to help halt the disease process.”

Our Ambassadors were so excited to hear what Dr. Zito had to say and felt so validated that she understood how they experienced life and inspired as she shared best practices for a physician-patient partnership.

LaRita, who is a patient of Dr. Zito, emphasized that Dr. Zito’s partnership philosophy was one of the reasons she loves being her patient and noted the need for more doctors who see patients as partners.

I’m so happy I had the chance to share a bit of this talk with you and would love to hear your thoughts in the comments below. Look for more updates from the meeting in the weeks ahead!

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