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also the greatest barrier, but pain and the unpredictability of how well patients would feel were also important (44%, 43%, and 34% of patients, respectively). Interestingly, responses from HCPs in the present study indicated that they considered pain, emotional stress, and disease fluctuation as the greatest barriers in the workplace, which is similar to the views of patients in the European/Canadian study. The burden of RA on patients is not limited to physical impacts. The psychological impact of the disease is also important as it has a negative effect on the course of the disease.18 However, physician–patient communications have traditionally focused on symptoms and treatment rather than on impact on the quality of life.10,19 Furthermore, two patient surveys conducted in the USA, Canada, and Europe found that patients with RA felt unable to effectively communicate with their HCP about their condition and treatment goals.20 The physical and emotional challenges of living with RA can make everyday activities difficult, so our study also explored these challenges. Similar to findings in the European/Canadian study,14 the physical effects of RA, such as pain, fatigue, and aching/stiff joints, were perceived by patients and HCPs as the primary barriers to undertaking activities, particularly exercising. Interestingly, the perception of how RA affects the ability to carry out housework differed greatly between patients and HCPs, with 59% of HCPs and only 23% of patients considering this activity difficult. As previously reported,14 inability to undertake or complete activities led to patients feeling anxious and frustrated.Patients’ feelings about the future can offer insight into the deeper impact of living with RA. Our study showed that patients had only modest aspirations for a future with RA. In total, 40% of patients felt that they would like to accept their RA despite the barriers it caused, and 20% would like to live their lives in the same way as people without RA. Similarly, in the European/Canadian study,14 57% of patients reported that they would like to accept their life with RA and be able to cope with it in the future.Despite a large proportion of patients feeling that the people around them understood the emotional impact of RA, nearly half hoped that this understanding would improve. This discrepancy may be due to a low patient expectation of the level of understanding of the impact of RA by the people around them. In contrast, HCPs more commonly believed that patients hoped for a better understanding of the physical impact of RA and that their physician would show more interest in their treatment. Understanding the physical impact of RA was perceived as an important aspiration by 61% of HCPs but only 34% of patients; this compared with 43% for patients in the European/Canadian study.14 Being able to go out with friends and accomplish everyday activities at home were important for patients, whereas HCPs perceived taking a holiday as a major aspiration, which is in line with patient results in the European/Canadian study.14 A recent multinational survey highlighted discrepancies between the views of patients with RA and HCPs, reporting that 90% of physicians were satisfied with their treatment-related communications with their patients but that 61% of patients were uncomfortable raising concerns or fears with their physician. Inadequate HCP–patient communication may explain the discrepancies between the views of patients and HCPs in our study, suggesting that improved communication could lead to improved management of RA. It is important to emphasize the relevance of the location of this study. Currently available PRO data for RA come from studies performed in Western populations; little is known about the impact of RA on patients’ lives in Saudi
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