"It means almost forgetting that you've got a disease": an OMERACT study to define independence in the context of rheumatoid arthritis remission from the patient perspective

AIMS: Our previous work identified pain, fatigue, and independence as missing from the ACR/EULAR rheumatoid arthritis (RA) remission criteria from the patient perspective. Validated measures exist for pain and fatigue, but not for independence. As a first step towards developing such a measure, this study aimed to understand 'Independence' in the context of RA remission from the patient perspective. METHODS: International qualitative research study comprising five focus groups of 19 participants with RA. Data were analysed using reflexive thematic analysis. RESULTS: Five overarching themes were identified, underpinned by a construct of "stages of independence". Independence means at least being 'physically and functionally able' but may go beyond this and enable 'participation beyond function', 'cognitive independence', and 'having or taking control'. There was no agreement on whether assistance is an aid to independence or undermines ability to achieve independence ('assistance is complicated'). The construct "Stages of independence" acknowledges that Independence may mean different things to different patients and there may be other factors beyond disease activity that hold patients in each of these stages. CONCLUSION: These novel data suggest a desirable definition of independence includes full active participation without the need to consider or work around disease activity, and cognitive independence from thoughts of RA. Independence in RA remission is a complex concept and next steps will be to seek patient and professional agreement on the most important issues raised in these focus groups to take forward to developing a measure for independence in the context of RA remission from the patient perspective