Background Combination therapy of disease modifying anti-rheumatic drugs (DMARDs) is a required standard at diagnosis of early rheumatoid arthritis (RA). Patients are often prescribed combination treatments at their first appointment. This can be difficult to comprehend as dosage regimes are different for each DMARD. This may lead to poor compliance and treatment failure.
Objectives We have produced a pictorial leaflet to explain the different drug regimes of the four most commonly prescribed DMARDs in early RA treatment: hydroxychloroquine, methotrexate, sulphasalazine and leflunomide. These leaflets complement the ARC information leaflets. The aim is to improve patient understanding, decrease anxiety and improve concordance at this critical stage in their treatment.
Methods The department consultants agreed starting dose regime for the introduction of methotrexate + folic acid supplementation, sulphasalazine, hydroxychloroquine and leflunomide. We produced an A4 tri fold colour leaflet showing the life size tablets with clear and simple explanation of the dosage regimes and blood monitoring instructions. The design also allows patients to receive consistent instructions from all members of the multi-disciplinary team. The pictorial leaflets were piloted in rheumatology outpatients and feedback was obtained from patients and general practitioners with a questionnaire asking their opinion.
Results 50 responses were received from patients and general practitioners. Of these 48 felt the leaflet was clear and easy to read. 37 had received previous written information on disease modifying anti-rheumatic drugs and of these 36 reported the leaflet was more useful than a standard leaflet. 47 felt it improved patients' understanding of combined DMARD treatments.
Patients reported that there was “very clear information on combined DMARDs therapy” and that the leaflet was a “useful visual memory aid”. One patient reported that the “leaflets are handy to keep with you in a medical folder, so that you can you can always look back and read information you may have forgotten”.
Conclusions Information in a pictorial format enhances patient's understanding of combined DMARD therapies. This is particularly useful for the elderly, those with poor reading skills and those where English is not their first language. It provides a useful visual aid as an adjunct to the more detailed drug information leaflets and should improve compliance with medication.
Disclosure of Interest None declared