Patient-reported outcome measures (PROMs) and clinical decision-making in inflammatory rheumatic conditions: a systematic review.

Abstract

Objectives: To examine the role of patient-reported outcome measures (PROMs) in clinical decision-making across three inflammatory arthritides: RA, PsA and axial SpA (axSpA).

Methods: We conducted a systematic review of four online medical literature databases (MEDLINE, Embase, CINAHL, Cochrane Central) from inception to February 2025. Abstracts and full texts were independently double-assessed. Articles examining the use and influence of PROMs on RA, PsA and axSpA clinical decision-making were included, with extracted data narratively synthesised (PROSPERO registration: CRD42024550525).

Results: From 16 950 identified studies, 29 were included (n = 22 RA, n = 4 axSpA, n = 3 PsA; study design: n = 15 trials, n = 10 cohort, n = 4 cross-sectional). PROMs supported three aspects of healthcare: treatment decision-making (n = 24), clinical encounters (n = 2) and self-monitoring (n = 6). Treat-to-target studies (n = 14/24, commonly RA) used PROMs to guide drug alterations. However, clinicians adhered less to PROM-based treatment protocols for complex patients or those with restricted insurance policies. PROMs improved patient communication and trust in clinicians. PROM-based self-monitoring matched standard care outcomes, but service limitations reduced its efficiency.

Conclusion: PROMs capture valuable patient data and show potential to support clinical decision-making, particularly in RA patients. Current PROM implementation methods are varied. Standardisation could maximise the clinical value of PROM data that, if acted upon, could enhance patient care and outcomes. However, service and clinician barriers, combined with poor standardisation, currently risk these data being underutilised.