BackgroundAnkylosing spondylitis (AS) is a chronic disease requiring long-term treatment. Patients' beliefs about medicines and treatment may affect their treatment adherence and treatment success.ObjectivesIn this study, we aimed to investigate the relationship between beliefs about medicines and treatment adherence in AS patients.MethodsThis cross-sectional study was conducted in a single tertiary rheumatology clinic. One hundred and fifty three AS patients were enrolled to the study. Socio-demographic and medical characteristics of the patients were recorded to a patient interview form. In order to evaluate the general and personal views of the patients about drugs, the Turkish Translation of the Beliefs about Medicines Questionnaire (BMQ-T) (Cinar et al in 2016) was used. According to this survey, the beliefs about medicines are composed of the following sections: Specific Necessity, Specific Concerns, General Overuse and General Harm. Medication adherence was assessed by using the Morisky Green Levine Medication Adherence Scale (MGLS) (1986). Adherence was measured on a scale of 0 to 4, in which higher scores represent lower medication adherence and vice versa. Patients who reported a score of 0 on the MGLS were classified as adherent. All other patients were classified as nonadherent. Categorical variables were compared with Chi-square test, while continuous variables were compared with independent samples t test. To evaluate potential risk factors for non adherence, logistic regression method was used.ResultsThe mean age of the patients was 35.15±8.19 years. The mean time from first symptom (disease duration) was 10.0±6.1 years. The vast majority of the patients (n=145; 94.8%) were male. One hundred patients (65.4%) were using NSAIDs and 83 patients (54.2%) were using anti-TNF. According to the MGLS scores, 56 (36.6%) patients were compatible with treatment, and 97 patients (63.4%) were found to be incompatible with the treatment. As the BMQ-T-Specific Necessity scores increased, drug compliance was also increased (p=0.006), on the other hand, as the BMQ-T-Specific Concerns, BMQ-T-General Overuse and BMQ-T-General Harm scores increased, drug compliance was decreased (p=0.023, 0.002, <0.001, respectively). There were significant positive correlations between Specific Concerns (p=0.002), General Overuse (p=0.031) and General Harm (p=0.024) score levels with the increase in patients' BASDAI score. While there was significant correlation between the disease duration and the General Overuse scores in the negative direction (p=0.016), there was significant correlation between the disease duration and the Specific Necessity scores in the positive direction (p=0.002). As 1 unit increase in the BMQ-T-Specific Necessity score decreased the risk of treatment nonadherence by 0.38 fold, on the other hand, 1 unit increase in the BMQ-T-General Harm score raised the risk to 3.21.ConclusionsIn our study, the belief of AS patients about the necessity of treatment they were using, found to increase treatment adherence, while ...
BackgroundAnkylosing spondylitis (AS) is a chronic, progressive, inflammatory disease which can cause labour loss and deformities and requiring long-term treatment. Loneliness, perceived social support, depression, patients‘ beliefs about medicines and treatment may affect their medication adherence and treatment success.ObjectivesIn this study, we aimed to investigate the relationship between loneliness, perceived social support, depression and medication adherence in AS patients.MethodsThis cross-sectional study was conducted in a tertiary rheumatology outpatient clinic. One hundred and nineteen AS patients were enrolled to the study. The socio-demographic and clinical features of the patients agreeing to participate were recorded to the “Patient Assessment Form”. The patients‘ disease activity and functional status were determined with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI, and the Bath Ankylosing Spondylitis Functional Index (BASFI), respectively. The pain and global assessment of the patients‘ were assessed with a numerical visual analogue scale (nVAS; 0–10 cm). The medication adherence of the patients was assessed with the Morisky Green Levine Scale (MGLS). The UCLA Loneliness Scale, the Multidimensional Scale of Perceived Social Support (MSPSS) and the Beck Depression Inventory (BDI) were used to determine loneliness, perceived social support, and depression of the patients.ResultsOne hundred five patients (88.2%) were male, the mean age was 35.80±9.08 years, and the mean disease duration was 9.88±6.34 years. The mean BASDAI, BASFI and patient global assessment scores were; 4.57±2.63, 3.23±2.76, and 4.13±3.23, respectively. According to the MGLS medication adherence groups, patients with low medication adherence had higher BASDAI, spinal pain, spinal pain at night, fatigue and patient global assessment scores and had lower mean ages (p<0.05). Among the MGLS medication adherence groups, patients with low medication adherence had lower MSPSS scores, and had higher UCLA Loneliness Scale and Beck Depression Inventory scores (p=0.037, p<0.001, p=0.022, respectively) (table 1).Abstract AB0841 – Table 1Comparison of the perceived social support, depression and loneliness scores with the Morisky Green Levine Scale subgroups.Morisky Green Levine medication adherence groups CharacteristicsOverall High (n=43)aMedium (n=66)b Low (n=10)cFp Multidimensional Scale of Perceived Social Support total score12–84*63.52±17.1365.09±16.8564.65±16.5949.30±17.013.9580.022Beck Depression Inventory (0–63)*13.65±10.4113.07±11.2912.15±8.5126.10±10.738.952<0.001UCLA Loneliness Scale20–80*37.34±11.2235.19±11.2637.56±10.9045.20±10.563.3880.037F: Oneway ANOVA, Statistically significant between a and c, and b and c (p<0.05). * It shows the lowest-highest scores that can be taken from the scale and its sub-dimensions.ConclusionsIn this study, it was shown that as the average age and social support scores of patients decreased, and as the BASDAI, spinal pain, spinal pain at night, fatigue, patient global assessment, l...
BackgroundSeveral surveys indicate that the complementary and alternative medicine (CAM) use is especially prevalent in patients with chronic painful conditions like ankylosing spondylitis (AS). Despite good treatment options such as tumor necrosis factor alpha (TNFα) inhibitors in AS, it is seen that patients have applied for CAM use for many reasons including local regulatory funding requirements, potential risks and accessibility of biological treatments. Few studies have examined the frequency of CAM use, and associations between demographic and disease-related factors of it in AS.ObjectivesTo investigate the CAM usage of patients with AS and to determine the associated factors.MethodsTotal of 123 patients with AS, who were being followed in a tertiary rheumatology outpatient clinic, were included to the study. The demographic and clinical features along with the behaviors about the CAM usage of the patients agreeing to participate were recorded to the “Patient Assessment Form”. The activity of the disease were determined with doctor global assessment (numeric visual analog scale (nVAS; 0–10), and Routine Assessment of Patient Index Data (RAPID)-3 score. The treatment adherence of the patients was assessed with the Morisky Green Levine Scale.ResultsOne hundred eleven patients (%90.2) were male, and mean age was 36.5±8.8 years. The mean disease duration and mean delay in diagnosis were 10.9±6.4, and 3.7±3.9 years, respectively. The mean RAPID3 score, doctor and patient global assessment were; 9.9±5.3, 2.8±1.9, and 4.6±2.7, respectively. While 79 patients (%64.2) were on anti-TNF treatment, 76 patients were receiving NSAIDs, and 35 patients (%28.5) reported an adverse event related with the treatment. Forty-five patients (%36.6) reported to use any CAM (previous or current) (Table1). The reasons reported by the patients for the usage of CAM; media in %13, recommendations from family members or relatives in %10.6. It has been found that in married patients, the ones with lower the Morisky Green Levine Scale score (high adherence), CAM usage was statistically high (p<0.05). Receiving NSAIDs or anti-TNF agents was not statistically associated with CAM usage. The underlying expectations for the usage of CAM were; considering it might be helpful in %27.6; considering it might heal in %17.9; to relieve the pain in %14.6; and preventing to deteriorate the disease status in %12.2.Table 1.Types of CAM useCAM Typen*% Plants and herbs3125.2Massage1310.6Spa108.1Praying/spiritual approach64.9Cupping32.4Imagining21.6Naturapati21.6Acupuncture10.8CAM, complementary and alternative medicine. *There are patients marked the method more than one.ConclusionsIn our study, we found that approximately one third of our AS patients were using CAM. When compared with the literature related with other diseases, CAM usage in AS patients was somewhat lower. Our results have demonstrated that treatment adherence was higher in those using concomitantly CAM in their therapy.Disclosure of InterestNone declared
Background Pain, stiffness, fatigue and sleep problems are the most important symptoms of ankylosing spondylitis (AS) patients. Among these symptoms, inflammatory back pain is a major symptom reported by all AS patients. Although there are various quantitative studies reporting that pain is one of the most serious and prevalent problems during the course of AS, there are no detailed qualitative studies on how pain affects the AS patients physically, socially, emotionally, and economically. Objectives The aim of this study was to determine the pain experiences of patients with AS and the effect of pain on their lives by the method of direct interview. Methods This qualitative case study included 23 patients with AS. The data was collected by using both a demographic data form and a semi-structured interview form. Each patient was interviewed face-to-face. The data obtained was evaluated using a content analysis method. Results The data was analysed in 6 categories and 4 subcategories. The categories included the following: (1) pain as described by the patient, (2) the effect of pain on daily routine activities, (3) the effect of pain on social life, (4) the effect of pain on employment, (5) the effect of pain on family life, and (6) the emotional effects of pain. During periods of pain, patients indicated that they experienced difficulty in carrying out their daily routine activities and in meeting their personal needs. Pain also prevented them from fulfilling their responsibilities in the family, inhibited their social relations and caused trouble at their workplace. Due to the negative effects of pain in their lives, the patients felt helplessness, fear, stress, sadness, and unhappiness. Conclusions Besides being asked about the quantity of pain, patients with AS should also be questioned on how pain affects their lives. Such an approach would guide the health care workers in planning and applying health care specific for each individual patient. References Chorus AM, Miedema HS, Boonen A, Van Der Linden S: Quality of life and work in patients with rheumatoid arthritis and ankylosing spondylitis of working age. Ann Rheum Dis 2003; 62:1178-84. Hakkou J, Rostom S, Mengat M, Aissaoui N, Bahiri R, Hajjaj-Hassouni N: Sleep disturbance in Moroccan patients with ankylosing spondylitis: prevalence and relationships with disease-specific variables, psychological status and quality of life. Rheumatol Int 2013; 33(2):285-90 Özgül A, Peker F, Taskaynatan MA, Tan AK, Dincer K, Kalyon TA. Effect of ankylosing spondylitis on health-related quality of life and different aspects of social life in young patients. Clin Rheumatol 2006; 25: 168-174 Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.2407
Background Therapies for ankylosing spondylitis (AS) have entered a new era of optimism with the advent of TNF inhibitors (TNFis), which make remission as an achievable goal for most of the patients. Overall, data obtained from the clinical trials and post-marketing suggests that TNFis appear to be safe and well tolerated. However, risk of infections and malignancies stands as the major area of concern with these agents. Such concerns led to the development of recommendations and safety regulations for the rheumatologists, while these initiatives helped little to relieve the patients’ anxiety. Indeed, “word of mouth” uncertainty regarding some of the potential side effects of these agents is a major cause of reluctance among the patients using these agents. To overcome reluctance caused by uncertainty, it is important to gain an insight about the patients’ perceptions for these agents. Objectives To investigate the patients’ views about their treatments and the factors that influence patients’ treatment decisions in patients with AS who have been using TNFis. Methods This descriptive study was conducted in a single rheumatology unit between September 2011 and January 2012. AS patients who had been using TNFis at least 3 months were included to the study. Demographic and clinical characteristics of patients who accepted to participate in the study were recorded. Patients’ thoughts and perceptions about their treatment were evaluated with using a standard questionnaire given to the all patients. Results A total of 70 patients were recruited. The mean age was 35.9±7.1 (20-50) years, and 94.3% of them were male. The mean duration of illness was 8.8±5.6 (2-32) years. The mean BASDAI score was 3.2±2.3. The frequency of using etanercept, infliximab and adalimumab were 50.0%, 18.6%, and 31.4%, respectively. Patients described their feelings at the time of prescription as hopefulness (78.6%), anxiety (42.9%), fear (20%), desperate (12.9%), and hopeless (10%). The most significant determinant for acceptance of TNFis treatment was stated by patients as hope to heal (81.4%), trust in his/her physician (74.3%), recommendation by other patients (41.4%). After the information regarding TNFis were given through standard forms, patients described their feelings as, increase in anxiety (47.1%), psychologically wearisome (35.7%), and worrying to become worse in the future (28.6%). Following treatment with these agents, patients described their experience as “I recommend to other patients” (71.4%), “it saved my life” (64.3%), “I judge regulatory exams necessary” (77.1%), and “I feel secure by 3-monthly exams” (68.6%). Conclusions This study, to our knowledge, is the first in evaluating the attitudes of patients to TNFis, starting from the stage of informed consent to the stage of post-experience. We found that standard forms of informed consent causes an increase in the level of anxiety among new users of TNFis, while they are not supposed to do so. In this regard, wording of informed consents can be re-edited in a way to increa...
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