Background In the current recommendations for early rheumatoid arthritis (RA) management, the focus is set to achieve clinical remission as soon as possible with an early and intensive treatment. Our previous research indicated that rheumatologists’ perception of patients’ concerns at initation influenced their prescription behaviour of intensive combination treatment strategies (ICTS). Understanding patients’ perspectives on ICTS is necessary to identify opportunities to improve early RA care.
Objectives To explore early RA patients’ perceptions of and experiences with ICTS at an early stage in their care process.
Methods A qualitative study was carried out using individual semi-structured interviews with early RA patients who agreed to ICTS within the CareRA trial four months earlier. The CareRA trial is a multicentre RCT across Flanders comparing different ICTS for early RA with conventional DMARDs plus step-down glucocorticoids. Data saturation was reached after 26 interviews. Each interview was recorded, transcribed literally and thematically coded using the constant comparative method.
Results Patients indicated that when ICTS was advised they were afraid of the side-effects in the short term and of the health consequences of the treatment in the long-term. At the same time, many patients reported that it was confronting to hear what the treatment entailed just after being burdened with the diagnosis of RA. Motivations for the decision to agree with intensive treatment initiation were faith in the treatment and healthcare team and knowing the medication would be phased out eventually. Patients who initiated ICTS reported that their negative feelings disappeared and that ICTS was easily incorporated into their daily life.
Conclusions Despite their concerns when ICTS was advised, most patients had positive experiences with ICTS once initiated. The study findings may be helpful for healthcare professionals to understand patients’ concerns and to support them in their decision-making process to initiate ICTS.
References Meyfroidt S, van Hulst L, De Cock D, Van der Elst K, Joly J, Westhovens R, Hulscher M, and Verschueren P. (2012) Intensive combination treatment strategies for early rheumatoid arthritis: a qualitative study of rheumatologists’ and nurses’ experiences and views. Manuscript submitted for publication.
Acknowledgements The authors thank the healthcare professionals and their patients for their participation in this study.
Disclosure of Interest None Declared