• Shared decision-making includes both the doctor and the person living with rheumatoid arthritis (RA) in the process of making a treatment plan.
• Shared decision-making has been found to improve satisfaction with RA treatment and to help people stick with their treatments.
• Many doctors acknowledge there are treat-to-target strategy recommendations — taking into account the potential risks and benefits of each treatment option, along with the goals and preferences of those in their care.

Shared decision-making involves the doctor and the person living with rheumatoid arthritis working together to make important medical decisions.¹ Since RA is a chronic rheumatic disease, ongoing treatment decisions are best made as a collaborative partnership between you and your doctor. Discussing topics such as your treatment preferences, lifestyle, and family responsibilities can help your doctor recommend the treatment plan that will best suit your individual needs.

Why Is Shared Decision-Making Important for People With RA?

RA is a chronic disease that currently has no cure.² For the best outcome, it is important to take charge of your treatment and give your input regarding how you want to manage your RA. There are several treatment options for RA, and it is recommended that most people begin their treatment with disease modifying antirheumatic drugs (DMARDs) as early as possible after an RA diagnosis.^{2, 3}

Read more about the benefits of starting and staying on treatment for RA.

Conventional DMARDs, such as methotrexate, are commonly prescribed as the first treatment for RA.⁴ However, some people may not respond well to methotrexate alone and may require other medications to help control their disease.

Biologic and targeted DMARDs have different potential side effects and risks. Some are taken orally, while others are injected. It is important to discuss these medications and their risks and benefits with your rheumatologist to figure out which treatment options are best for you.

A study published in 2020 found that people with RA are more likely to be satisfied with their treatment when shared decision-making is used to develop their treatment plan.⁵ This may be especially true when it comes to choosing a medication to treat your RA.

The Doctor’s Role in Shared Decision-Making

The doctor’s role in shared decision-making is to help people with RA understand their treatment choices and the risks and benefits of each, and to answer any questions.⁶ Doctors know there is no single treatment that works for everyone. Your input is valuable as they decide what to recommend.

Your doctor should involve you in the decision-making process during your visits. They may ask about your goals and concerns. When discussing treatment, they will go over the benefits and possible side effects of all of the medications, providing up-to-date information from studies and clinical trial results.

Your doctor may also ask what is important to you. You may need to discuss your family responsibilities and receive input from relatives or close friends. It’s OK to discuss these topics at a follow-up appointment, after you’ve had some time to think them over. Laying out the next steps can help you and your doctor work together to set achievable goals when it comes to managing your treatment.

Treat To Target

Treat to target (T2T) is an approach rheumatologists and those in their care may use to set goals, monitor progress, and choose treatment plans to reach those goals.⁷ The goal of RA treatment is to achieve remission, which occurs during periods when your symptoms are under control. After you start a treatment plan, your rheumatologist will regularly monitor the safety and effectiveness of your treatment through discussion and testing.⁸

If the goals of treatment are not being met, you and your rheumatologist will discuss possible changes. These might include trying a different dosage, adding another medication, or changing to a different medication entirely. T2T has been shown in studies to help some people with RA reach remission and one study showed that some patients were able to maintain it for up to three years.⁷

The T2T approach has also been shown in another study to be an effective method for treating those with longstanding RA, helping them achieve a low disease activity state. In fact, it can help people stay on their treatment plans, and this may allow for improved outcomes.⁷

Your Role in Shared Decision-Making

Your role in shared decision-making is just as important as your doctor’s.^{9, 10} Since your treatment decisions affect not only you, but potentially others in your life, your priorities, preferences, and values must be considered.

During your appointments, it is important to be open and honest with your doctor, especially if you have challenges sticking with treatment. There is no need to feel embarrassed. Be sure to let your doctor know about issues like:

• Trouble affording medications
• Forgetting to take medications
• Fear of needles
• Concerns about side effects
• How the medication might affect family planning
• Wondering whether the medication is really working
• Doubts about whether you still need the medication if you start feeling better

Ask any and all questions you have about each treatment option. It’s your doctor’s job to answer these questions. If time for discussion is too limited, ask whether you can schedule a follow-up appointment in person or via telephone, or send your questions via email or a health care communication platform.

Read more about smart ways to stick to your RA treatment plan.

Track Symptoms and Side Effects

It can also be helpful to keep copies of your medical records and a journal of the RA symptoms and any side effects you experience from your current treatment.¹¹ For example, if you take methotrexate and notice gastrointestinal symptoms, you can let your doctor know. They may prescribe something to help manage this side effect. Note the time of day you take the medication and how long it takes for the side effects to begin. Does anything make them better or worse?

Taking Family Into Account

Family obligations may be an important factor to consider in rheumatoid arthritis care. Some medications are given by infusion at regular intervals, requiring clinic visits for appointments. This schedule may not be feasible for some, so other treatments need to be considered. The side effects of some medications may also make it difficult to perform everyday tasks. Ask your doctor about which treatment options will best allow you to meet your family’s needs.

Considering Treatment Goals for RA

Treatment goals for managing RA are typically focused on managing symptoms, improving function, reducing long-term complications, and improving overall well-being.¹² However, people living with RA may set personal goals for themselves that encompass more than just improving clinical parameters.

For some, returning to an activity they miss may be important. Making a list of favorite activities or things you would like to accomplish can be a motivator to stick with treatment.

Living a healthier life is also important, which may include getting more exercise or daily movement. Talk about these personal goals with your doctor so they can better understand your reasoning and motivation.

Shared decision-making is a great tool that allows you and your doctor to collaborate. The stakes are high — an effective treatment plan can improve your overall quality of life and health outcomes.

Communicating your needs and experience to your rheumatologist will help you to stick with your treatment plan. Your doctor is your best partner in managing your RA.

Talk With Others Who Understand

On myRAteam, the social network for people with rheumatoid arthritis and their loved ones, more than 171,000 members come together to ask questions, give advice, and share their stories with others who understand life with RA.

How open are you with your doctor? What do you wish your doctor would do differently? Share your thoughts and experience in the comments below, or start a conversation by posting on myRAteam.