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

Heidi Lempp,David L Scott,Darija Hofmann,Stephani L Hatch

doi:10.1186/1471-2474-13-200

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.

Highlights

Combinations of disease-modifying anti-rheumatic drugs (DMARDs) are increasingly used to control active rheumatoid arthritis (RA); there is little information about patients’ perspectives, their expectations, concerns and experiences of this intensive treatment
Combination therapy has been proven through randomised controlled trials as effective in the early disease process of Rheumatoid Arthritis (RA) [1,2,3]
Recruitment of patients We studied a quota sample of 18 patients, stratified by gender, ethnicity and disease duration (early RA diagnosis (< 2 years) receiving combinations of DMARDs; or established RA (>2 years) receiving either combinations of DMARDs or tumour necrosis factor (TNF) inhibitors combined with methotrexate, or an alternative DMARDs, based on the Rheumatology outpatient clinic population

Summary

Introduction

Combinations of disease-modifying anti-rheumatic drugs (DMARDs) are increasingly used to control active rheumatoid arthritis (RA); there is little information about patients’ perspectives, their expectations, concerns and experiences of this intensive treatment. Patients’ responses to the newly offered treatment in early RA tended to be more positive in comparison to rheumatologists who expressed a degree of reluctance in prescribing lots of medication This divergence is not new in RA care, as highlighted in the literature in relation to physical and psycho-social aspects of rheumatology care and its management [9,10,11,12]. In return such disagreement may interfere with patients’ cooperation when responding to their individually tailored needs Against this background of current sea change in the treatment of RA, the aim of our study was to explore expectations, the impact on quality of life, concerns and management of patients with newly diagnosed and established RA when in receipt of combination therapy

Objectives

Methods

Results

Conclusion