Resistance of rheumatoid arthritis patients to changing therapy: Discordance between disease activity and patients' treatment choices

Abstract

Objective. Despite advances in rheumatoid arthritis (RA) treatment, patients' decisions regarding therapy often deviate from expert recommendation. This study was undertaken to investigate patients' acceptance and satisfaction with therapy, willingness to change therapy, and reasons for not changing.Methods. Participants (n ‫؍‬ 6,135) completed an 11-item questionnaire concerning treatment preferences. Eight questions assessed reasons for not wanting to change therapy. The contribution of individual predictors was determined by logistic regression analysis.Results. Questionnaire responses showed that 63.8% of the patients would not want to change therapy as long as their condition didn't get worse; 77.3% were satisfied with their medications, while 9.4% were dissatisfied. These assessments were weakly related to RA activity and functional status. Side effects had occurred in 22.4% of the patients during the previous 6 months, and in 65.5% at some period during their lifetime. Predictors of unwillingness to change therapy were satisfaction with RA control, which had an odds ratio ( Conclusion. There is substantial discrepancy between declared satisfaction with therapy and measured RA activity and functional status. Most RA patients are satisfied with their therapy, even many with abnormal scores. Fear of loss of control of RA and fear of side effects are major patient concerns. Maintenance of current status, rather than future improvement, appears to be a high priority for patients.

Using Dermal Temperature to Identify Rheumatoid Arthritis Patients With Radiologic Progressive Disease in Less Than One Minute

“…Numerous reports have documented poor patient acceptance of expensive RA therapies and poor adherence to therapy 19. Assessment of joint temperature may help to identify patients with progressive, destructive RA who would benefit most from expensive, effective biologic therapy 2.…”

Polish Rheumatologists and Rheumatoid Arthritis Patients Differ in Their Opinions About Treatment Inefficacy

“…This finding is concordant with the results of a large study comprising over 6,000 patients, where more than three-fourths of the patients were satisfied with their therapy, but the majority of those patients had moderate or even high arthritis activity. 17 Satisfaction with RA control and risk of side effects were the dominant cause of unwillingness to change the therapy. 17 In another study, 65% of 97 patients with moderate to high disease activity did not want to change their current medications.…”

“…17 Satisfaction with RA control and risk of side effects were the dominant cause of unwillingness to change the therapy. 17 In another study, 65% of 97 patients with moderate to high disease activity did not want to change their current medications. Major causes of unwillingness to change were satisfaction with current disease state and perceived risk of side effects.…”

Shared decision-making in rheumatology : what matters to patients?

“…It is possible that patients are more strongly invited to participate in the decision to decrease or stop their medication, because it is more preference sensitive. Previous studies have shown that patients fear returning symptoms (in the case of remission) or unknown side effects (when changing therapy) (119,120). More research is necessary to clarify why patients feel they are too much involved in the decision to decrease or stop medication.…”

“…Furthermore, patient participation is important because studies show that patients' and rheumatologists' beliefs about illness and treatment may differ. This includes how they rank the potential benefits and side effects of available treatment options and how they prioritize long-term outcomes (120,(129)(130)(131)(132)(133)(134)(135)(136)(137)(138)(139). Therefore high quality patient-physician communication about the choice of treatment is important.…”