Well-being and Medication Necessity Beliefs Among Patients With RA

Despite advances in therapeutics and treatment strategies for rheumatoid arthritis (RA) that impact well-being, patients in clinical remission still report reduced well-being,¹ according to an abstract presented at the European Congress of Rheumatology of the European League Against Rheumatism.

Researchers from Belgium evaluated 379 patients in the 2-year pragmatic treat-to-target Care in Early Rheumatoid Arthritis trial. These patients were treated with either a combination of conventional synthetic disease-modifying antirheumatic drugs (DMARDs) and glucocorticoid remission induction schemes or methotrexate monotherapy.

The patients in the trial had early RA and took 8 different questionnaires: Arthritis Self-Efficacy Scale, the multidimensional Fatigue Inventory, the Pittsburgh Sleep Quality Index, the Revised Illness Perception Questionnaire (IPQ), the Utrecht Coping List (UCL), the Short Form 36, RA Quality of Life questionnaire, and the Social Support List. Most were taken at baseline and weeks 16, 52, and 104; however, IPQ and UCL were only taken at baseline and week 16.

The researchers created 3 patient groups: all patients, patients in remission, and patients not in remission. They used the Patient Global Assessment on a Visual Analogue Scale (VAS) 0-100 as a proxy for well-being, and they constructed regression models to define week-being at weeks 16, 52, and 104. The 9 models (3 patient groups at 3 time points) were run with and without the VAS for Pain (VAS-Pain) for a total of 18 models.

In the models that did not include VAS-Pain, the most common variables were bodily pain, social function, and positive emotions. In the models that included VAS-Pain, the most common variables were vitality, social function, and identity.

The authors concluded that well-being and VAS-Pain were highly associated, even among patients who should theoretically have lower pain levels because they were in remission.

“Well-being is apparently difficult to define uniformly as many factors contribute to it,” the authors wrote. “Other well-being definitions could lead to different results and should be further explored.”

In a second abstract, researchers examined the associations of beliefs and concerns about RA medication necessity among patients with newly diagnosed RA.²

According to the authors, medication adherence is variable to DMARDs, despite the fact that these therapies are essential for early aggressive control of RA to reduce symptoms and disability. They analyzed 362 patients from the Canadian Early Arthritis Cohort who also completed the Beliefs about Medicine Questionnaire (BMQ) and the Patient-Reported Outcomes Measurement Information System 29-Item Profile.

More than half (54%) were classified as indifferent, 31% as accepting, 9% as ambivalent, and 6% as skeptical based on necessity and concern scores from BMQ. Indifferent patients were more likely to smoke, have a healthy weight, have low tender joint counts, and trend lower for Clinical Disease Activity Index score compared with accepting patients.

“Identifying medication indifference can prompt discussions about medication beliefs/concerns to facilitate shared decision-making and adherence,” the authors concluded.

References

1. De Cock D, Poffe T, Verbeke G, et al. The challenge of assessing well-being in patients with early rheumatoid arthritis. Presented at: EULAR 2020; June 3-6, 2020; Abstract FRI0035. https://ard.bmj.com/content/79/Suppl_1/591.2

2. Bartlett SJ, Schieir O, Valois MF, et al. More than half of newly diagnosed RA patients are not convinced of the necessity of RA medicines: associations with RA characteristics, symptoms, and function in the Canadian Early Arthritis Cohort (CATCH). Presented at: EULAR 2020; June 3-6, 2020; Abstract FRI0030. https://ard.bmj.com/content/79/Suppl_1/588.1