The RA NarRAtive Patient Survey [Interview][Transcript]

Dr_Ara_Dikranian_RA_NarRAtive_patient_surveyGuest: Dr. Ara Dikranian
Presenter: Neal Howard
Guest Bio: Dr. Ara Dikranian has been with SDAMC since 2004. He received his Bachelor of Science degree in psychobiology in 1991 and his medical degree in 1995, both from the University of Southern California. He is the current chair of the Arthritis Foundation San Diego chapter advisory board and volunteers his time for uninsured patients through the San Diego County Medical Association Foundation Project Access program.

Segment overview: Dr. Ara Dikranian of San Diego Arthritis Medical Clinic, member of the RA NarRAtive Advisory Panel, discusses rheumatoid arthritis and the RA NarRAtive patient survey that was conducted by Harris Poll on behalf of Pfizer.


Health Professional Radio – RA NarRAtive Patient Survey

Neal Howard: Hello and welcome to the program. I’m Neal Howard your host here on Health Professional Radio, thank you so much for joining us today. Our guest in studio today is Dr. Ara Dikranian, with SDAMC since about 2004. ‘Doctor D’ as he’s affectionately known to his patients, comes from a very long family line of health care providers following the footsteps of his father, grandfather and two uncles. He’s here today to talk with us about Rheumatoid Arthritis, it affects some nearly 24 million people worldwide and about a million and a half people here in the United States. It can develop at any time during adulthood, usually occurring though between the ages of 40 and 70 years. Our guest is a member of the RA NarRAtive Advisory Panel, here to discuss as I said Rheumatoid Arthritis and the RA NarRAtive Patient Survey that was conducted online including 15 countries by Harris Poll on behalf of Pfizer. Welcome to health Professional Radio Dr. Dikranian.

Dr. Ara Dikranian: Thank you Neal, it’s a pleasure to be here.

N: Talking about Rheumatoid arthritis, I mean my grandmother used to say “Oh, Arthur’s in the house today” or “It’s raining and Arthur’s gonna show up.” You’re considered an expert in the field of rheumatoid arthritis?

D: Yes, so it’s unfortunate that anyone is diagnosed with any type of arthritis but particularly rheumatoid arthritis which, yes we see on a daily basis as most rheumatologists would. But it is important for the general public to understand that rheumatoid arthritis is one of many different types of arthritis, the most common one being osteoarthritis which is more of a degenerative process that comes on with age and such. But rheumatoid arthritis is the one that most people are afraid of because it is the one that can cause many deformities and have many systemic manifestations as well.

N: What can you tell us about the importance of the survey? The survey that was conducted in 15 countries around the world and it was conducted online as I understand. Talk about why the survey was conducted in the first place.

D: Yeah, that’s exactly right. So the survey which is known as the RA NarRAtive was an initiative that has been supported by Pfizer but has been an international collaboration between rheumatologists and other health care professionals who manage patients with rheumatoid arthritis as well as patient and patient advocacy groups. And the purpose of it really was to bring a forum where the advances that the last decade or 15 years or so have seen in the management of rheumatoid arthritis might be better implemented in terms of better managing patients, having patients better understand their disease as well as setting goals and treatment plans. What this initiative has really identified is that despite these advances and therapies that there still are large gaps that remain in terms of inadequately treated patients and/or patients who may be access to treatment but aren’t getting the optimal treatment that they need.

N: You say there are large gaps, gaps being plural. What would you say in your opinion and based on the findings of the study, would you say is the, I guess least significant gap? Not an any of the gaps or insignificant but as far as the least significant gap that was identified and the biggest gap, the one that is really causing this inefficient treatment of RA.

D: Yes, certainly. So of course any of these gaps would be important but one of the most significant gaps is really in the communication between rheumatologists and patients. Part of that communication is logistical in terms of not having enough time to cover everything that’s needed. Both patients and rheumatologists in the survey agreed that more time is needed to adequately counsel patients to answer questions and set treatment plans, so that’s the logistical factor. The second part is that many patients despite being empowered to speak up or to voice their concerns about treatment, so that they were unable to do that either because of just anxiety about taking up too much time or even being seen as a problematic patients. In fact on out of three patients felt that if they raise too many concerns that their physician might recognize them as a problem patient. So that obviously is not conducive to a successful relationship nor a successful management plan. The other area where perhaps there was not as much of a gap was in the availability of community resources. So every country including here in the United States has multiple patient advocacy groups, support groups, informational resources which everyone recognizes as being really important and an integral part of sort of supplementing what’s not covered during the regular office visit. The gaps though in the community resources was that there’s an underutilization of these, for reasons that aren’t yet clear. So that’s something that we really as a panel need to explore a little bit further – why are these resources that should be used, are they being underutilized?

N: Is this the first survey or a fact finding mission? I guess for lack of better term, that has been conducted on behalf of rheumatoid arthritis research and treatment and management of patients or is this something that has been going on for some time and we’re simply getting more and more new information about RA?

D: Yeah, this particular survey, the RA NarRAtive is really the first and only to have an international scope that covers not just patients who have rheumatoid arthritis but in those who are managing the disease itself so it’s really unique in that regard. There are obviously have been previous large surveys that focused perhaps on countries or focused on a particular aspect of the treatment in terms of its efficacy or safety. We know that many countries have set up registries in terms of following patients with rheumatoid arthritis and how they do based on different treatments. But these are really focused on health care professionals, not so much on satisfaction on the part of patients. So this unique opportunity really sort of bridges that divide in terms of placing all the key stakeholders in managing rheumatoid arthritis from the patient to the health care professional to the advocacy groups supporting this endeavor and really identifying what gaps there remain despite the availability of various therapies.

N: Now you’ve mentioned patients, you say 1 in 3 patients would consider themselves, well would think that their doctor would consider them a problem patient if they raised too many questions or issues about their identified problem. Being a multi-cultural survey, did you find in the results differing mindset about patient-provider relationships or the perception of the physician being in a position of authority over the patient? Did you find anything that indicates a mindset that would make for better management?

D: Yeah, it’s a very godd question Neal and one that really we’re starting to explore. So obviously we have this survey results which are aggregate in nature, we’re just now starting to tease out countries specific results to see if some of these variables between lack of communication skills of satisfaction with communication that’s already been done have differences that might be varying from region to region or country to country and we can sort of hypothesize that’s some of those might be just cultural in nature. But I think the universal finding is really that despite patient perceptions or physician wishes to educate their patients, really a lack of time is universal. There are just too many patients with arthritis and physicians who are too pressed for time to really adequately counsel patients in all the aspects of disease management that are necessary. Which is why it’s even more important to utilize whatever resources we have in terms of patient advocacy groups or industry supported initiatives to really bridge that divide. So it’ll be interesting as this survey and its interpretation progresses on what areas may be identified that some areas, some countries are doing better than others and how we can utilize that to better improve patient management in our own region.

N: And where can our listeners go if they’d like to learn more about this survey and the initiative?

D: Yeah, so there’s a very good website setup by this initiative, it’s a very useful information and that is as the results of the survey as well as the methodology that’s been used to initiate it.

N: Thank you so much. You’ve been listening to Health Professional Radio, I’m your host Neal Howard. And we’ve been in studio talking with Dr. Ara Dikranian. Received his Bachelor of Science Degree in Psychobiology in 1991 and his Medical Degree in ’95 both from University of Southern California, completed his internship and residency in Internal Medicine and Fellowship in Rheumatology at The University of California following in the footsteps of his father, grandfather and two of his uncles. It’s been great having you here with us today Doctor and I’m hoping you’ll come back and speak with us in some more segments.

D: Thank you, I appreciate that.

N: Thank you. Transcripts and audio of this program are available at and also at and you can subscribe to this podcast on iTunes.