Positive mental attitude and rheumatoid arthritis

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Positive mental attitude and rheumatoid arthritis

The issue regarding why so many patients with rheumatoid arthritis (RA) do not adhere to their therapy, even in the early stages of their treatment, was brought up in two new studies presented at the European League Against Rheumatism Annual Congress (EULAR) 2016. These issues should be used to design strategies to improve treatment adherence that in turn will optimise the treatment outcomes and reduce the healthcare costs.

The main highlights were:

  • Patients who have autonomy through information seeking behaviour and have positive expectations about the track of their disease are much more likely to adhere to their treatment than those who feel less autonomous and become passive due to their joint pain.

  • At six months, patient anxiety on starting methotrexate therapy predicts non-response to treatment which might partly be explained by poor adherence.

In the first few months after diagnosis to initiate disease remission, patients with early RA should adhere to their disease-modifying antirheumatic drugs (DMARDs). Non-adherence to DMARDs interferes with the twin targets of RA treatment: first, obtaining low disease activity and second, decreasing radiological progression.

Dr. Johanna Hazes from the Erasmus Medical Centre, Rotterdam, The Netherlands said that “Non-adherence has been shown to be a serious problem in the treatment of RA. The consequences of non-adherence not only affects RA patients’ disease activity, but also the rheumatologist’s treatment decisions, which may lead to higher health care costs. However, it remains unknown as to why so many RA patients do not adhere to their treatment”.

To find out which early inflammatory arthritis patients are at risk for non-adherence in the first three months of treatment, a population of 259 adult patients, recently diagnosed with inflammatory arthritis and started on synthetic DMARDs, were interviewed. The objective was to identify potential adherence predictors, and their adherence continuously evaluated using electronically monitored pill bottles.

Initially, adherence was elevated but rapidly declined over three months of follow-up. Out of 15 different factors that could potentially influence adherence, ‘information seeking’ and ‘having positive expectations about their disease’ were the only ones importantly related to adherence. ‘Adjusting to the pain’ was linked with non-adherence.

The factors not linked with adherence included: negative feelings, depression, non-specific anxiety,  disability, and responses to questions covering patients’ perceptions of the necessity for their treatment and of any potential harm (including adverse effects) from their medication.

Anxiety on the onset of methotrexate treatment could lead to poor adherence

As per Dr. Suzan Verstappen of the Centre for Musculoskeletal Research, University of Manchester, UK, "Methotrexate is the DMARD of first choice in the treatment of RA; however, response to methotrexate is highly variable. Being able to predict which of our RA patients are likely to not respond would enable us to provide earlier access to alternative drugs with the hope of avoiding disease progression in some of our patients”.

In a population of 781 adult RA patients, data on potential predictors of response to methotrexate was obtained at baseline via questionnaires, case notes, and blood samples. No response to treatment was explained as failing to fulfil EULAR criteria for a good response: disease activity score (DAS)-28 at six months ≤3.2, and reduction in DAS28 from baseline to six months >1.2. Dr. Verstappen culminated that “From a long list of lifestyle, clinical and psychosocial predictors at baseline, BMI, smoking and DAS28 score were each shown to significantly predict non-response six months after patients had started treatment with methotrexate. Of particular interest, however, is the role of participant anxiety on starting treatment with methotrexate in predicting response, which is likely to be the result of its negative effect on adherence”.



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Original title of article:

Positive mental attitude improves treatment adherence in rheumatoid arthritis

Exploratory, Methotrexate, European League Against Rheumatism Annual Congress (EULAR), Disease-modifying antirheumatic drugs (DMARDs), Rheumatoid arthritis (RA), Pain, Adherence
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