Background It is recommended to start early, intensive and tight-controlled treatment with disease-modifying antirheumatic drugs (DMARDs) within 3 months of diagnosis to induce disease remission and to prevent joint damage. However, patients may be reluctant to start taking their DMARD medication. Factors that influence adherence behavior in established arthritis patients have been explored in several studies, but little is known about factors that influence the first start and adherence to DMARD therapy.
Objectives To ascertain the reasons given by persons recently diagnosed with Rheumatoid Arthritis (RA), Arthritis Psoriatica (AP) or polyarthritis for starting and continuing DMARD therapy. To compare factors that influence the first start of DMARD therapy with factors that influence subsequent adherence to DMARD therapy.
Methods Using a semi-structured interview schedule based on a literature review and the Health Belief Model, focus groups and individuals were interviewed in Rotterdam, (the Netherlands) between June 2009 and January 2011. The interviewees were all adult patients diagnosed less than two years previously with RA, AP or polyarthritis, who had been prescribed DMARDs. The interviews were transcribed verbatim and responses were extracted from the data if they included reasons for adherence or non-adherence to DMARD therapy and coded with the dominant word that summed up the reason by two coders separately. The two coders got together to discuss their findings and resolve differences. The codes were then classified into overarching factors. We added up the numbers of reasons in the initiation phase and in the adherence phase to compare which factors are dominant in both phases.
Results 6 focus group interviews and 10 interviews with individuals were conducted with a total of 34 participants. 6 groups of factors for adherence to DMARD therapy emerged: 1) medication-related factors i.e. actual or anticipated side-effects, expectations about the medication and perceptions of the medicine; 2) the severity of complaints; 3) communication with and trust in the rheumatologist; 4) the need to share in decision-making; 5) the ability to fit the medication schedule into daily life and 6) information about medication. The two most important factors determining whether DMARD therapy was started were the communication with and trust in the physician, and perceptions about medication. Factors that start to play a role in subsequent adherence are experiences with the medication (such as side-effects), the ability to fit the medication schedule into daily life, and wanting to share in decisions about the medication.
Conclusions Different factors determine whether RA, AP and polyarthritis patients start DMARD therapy and whether they subsequently adhere to it. The rheumatologist has a significant influence on both the initiation of DMARD therapy and subsequent adherence to DMARD therapy. For new patients, the communication with the patient is an important factor. In the continuation phase, the rheumatologist should be aware that patients might be more likely to continue the treatment if allowed to share in the decision making.
Disclosure of Interest None Declared
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