Patients’ views about treatment with combination therapy for Rheumatoid Arthritis: a comparative qualitative study

Abstract

BackgroundCombinations of disease-modifying anti-rheumatic drugs (DMARDs) are increasingly used to control active rheumatoid arthritis (RA); however there is little information about patients’ perspectives, their expectations, concerns and experiences of this intensive treatment.MethodWe interviewed a quota sample of 18 patients from a single tertiary outpatient clinic, stratified by gender, ethnicity and age, based on the outpatient clinic population. Patients with early RA (<2 years) received combined conventional DMARDs; patients with established RA (>2 years) received combined conventional DMARDs or DMARDs with biologics.ResultsFour main themes emerged from the analytical framework: (i) patients’ expectations about the combined treatment focuses mainly on physical symptoms; (ii) the impact of the treatment on quality of life varied with the new medication in both groups (iii) concerns about new interventions concentrated mainly on potential side effects; and (iv) combination therapy can be self-managed in close collaboration with clinic staff, but this requires individualised management approaches. These themes resonate with von Korff’s collaborative management of chronic illness model.ConclusionTo our knowledge this is the first qualitative study that examined systematically in patients with early and established RA their expectations, impact on quality of life, concerns about side effects and the management of the treatment when taking combined medication with DMARDs or DMARDs and biologics. Patients have generally positive views of combination DMARDs. Within routine practice settings, achieving medication concordance with complex combined DMARD regimens is challenging, and the concerns vary between patients; careful individual assessments are essential to successfully deliver such intensive treatment.

Examining patient preferences in the treatment of rheumatoid arthritis using a discrete-choice approach

“…On the contrary, it has been reported that combination therapy with MTX is usually well accepted by RA patients,18,21,22 and thus our results suggesting a preference for monotherapy may seem contradictory. Previous studies did not assess combination therapy within the framework of other relevant (second-line) DMARD attributes though.…”

Validation of an instrument to measure patients&rsquo; experiences of medicine use: the Living with Medicines Questionnaire

“…Patients’ perceptions concerning the desired therapeutic outcome influence both attitudes and behaviors toward medicine 32,33. Concerns about potential harm from side effects, long-term use and/or dependency are common 10.…”

“…Practical difficulties with the long-term use of medicines have been documented as burdensome,37–39 while the burden of managing medicine routines has been reported as demanding of both time and resources 8,18. There is also evidence that many patients manipulate their medicine regimens, especially when they experience unbearable burden, perceive their medicines as inappropriate or are dissatisfied with their medicine 33,40–42. Conversely, regimens which are inconvenient may lead to perceived lack of control or autonomy.…”

Behavioral Determinants of Self-Management Behaviors in Rheumatoid Arthritis Patients: A Qualitative Study

“…In the present study, some participants considered reluctance and/or negative attitude towards use of medications, diet, exercise, and social interactions as predisposing factors for failing to adopt SMB. In studies by Dixon and Bansback (27), Lempp et al (28), patients had negative attitudes towards medications and their side-effects. Furthermore, in this study, some of the female participants expressed negative attitudes towards using canes or neck orthotics and supports due to the fact that their devices were not accepted by their partner and perceived as a sign of disability.…”