Purpose: “Tight control” is a decision strategy widely advocated for the optimal treatment of patients with diabetes and rheumatoid arthritis (RA). Its purpose is to slow progression of illness by changing treatment when activity exceeds a minimum threshold. Despite considerable evidence that this strategy leads to improved outcomes, it has not been consistently adopted. We propose that patients' experience of illness complicates this decision strategy, and that recognizing how patient experience interacts with disease activity can enhance the implementation of tight control in clinical practice. The objective of this study was to identify experiential factors that combine with disease activity to influence actual treatment changes among RA patients.
Methods: We conducted a prospective, repeated measures, study in which RA patients were interviewed at baseline, 2, 4, and 6 months. Disease activity was measured with a validated patient report outcome measure. Patient experience was measured using the with the 8-item Brief Illness Perception Questionnaire, perceived recent change in illness severity, and the discrepancy between patients' current and desired health status. Generalized estimating equation (GEE) models determined whether these factors combined with disease activity predicts subsequent treatment changes better than disease activity alone.
Results: As summarized in the Table, several interactions between patient experience and disease activity were significant and predicted escalation better than disease activity alone.
Conclusions: Because specific patient experience factors influence future treatment changes, incorporating patient measures into a tight control decision strategy may broaden and encourage its use in clinical practice. 
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