Background With significant advancements in new treatment modalities for rheumatoid arthritis with biological therapies, the literature has largely focused on quantifying improvements. However from an extensive review of the literature very little evidence is available relative to experiences of mobility in this group after commencing biologic drug therapy. A challenge exists in informing services of what patients truely experience with changes to their pharmacological management. Furthermore if they notice changes, how do they value them. Three key qualitative publications were identified. Marshall et al (2004) reported improvements in physical function, pain and well-being. Arkell et al (2013) found that participants were very positive about being on anti-TNFα as it was described to make dramatic changes in their physical symptoms. Linden and Bjorklund (2010) concluded that with successful anti-TNFα treatment most participants experienced dramatic changesincluding a return to leisure interests. However Linden & Bjorklund (2011) also suggested that such dramatic changes may risk overuse and consequent strain. The aim of this study was to use a qualitative method to explore the understanding and experiences of People with Rheumatoid Arthritis (PwRA) who are receiving biological therapy treatment, relative to their physical function and lower limb mobility levels.
Methods An interpretative phenomenological analysis (IPA) approach was used to explore the understanding and experience of PwRA when receiving biologics. A purposive selection of a small sample of PwRA was adopted and in-depth semi structured interviews were used. Interviews were conducted in the homes of participants and then later transcribed verbatim. Thematic analysis was employed for identifying meanings, analysing and reporting patterns within data.
Results Five PwRA participated in the study. The mean duration of their RA disease was 20.2 years (range 6 -32 years) and all were being treated with biologic therapies. Four key themes emerged from the interviews: 1) Life before biologic treatment. 2) Life with biologic treatment. 3) Sense of self. 4) Podiatric implications.
Conclusions The findings from this study reinforce those known such as improved physical function. The dramatic, postive change experienced by participants and a sense of appreciation was linked with physical improvements and a return to activity. However there are consequences to these improvements. Regardless of improvements in physical ability and reduced pain, it emerges that lower limb complications are an ongoing experience for people receiving biologics. Importantly an ongoing need for foot health advice and management involving the multidisciplinary team in this patient group is warranted.
Arkell P, Ryan S, Brownfield A, Cadwgan A and Packham J (2013). Patient experiences, attitudes and expectations towards receiving information about anti-TNF medication – “It could give me two heads and I'd still try it!”. BMC Musculoskeletal Disorders, 14:165–172.
Linden C and Bjorklund A (2010). Living with rheumatoid arthritis and experiencing everyday life with TNF alpha blockers. Scandinavian Journal of Occupational Therapy, 17: 326–334.
Marshall NJ, Wilson K, Lapworth K and Kay LJ (2004). Patients' perceptions of treatment with anti- TNF therapy for rheumatoid arthritis: a qualitative study. Rheumatology, 43:1034 -1038.
Disclosure of Interest None declared
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