New UK research has challenged the assumption that people with rheumatoid arthritis always take their medication as prescribed.
Researchers from the Arthritis Research UK Centre for Epidemiology at The University of Manchester found that 40% of patients scored low on an adherence questionnaire at least once during their time in a recent study, indicating that they might not be taking their expensive biological therapies as regularly as prescribed.
Their research is published online in the journal Rheumatology.
The findings have prompted Arthritis Research UK’s head of health promotion to encourage people with arthritis to seek out further information and advice so that they are able to better understand the medication they have been prescribed, its positive benefits for their condition and the reasons for taking it as directed.
Belinda Wadsworth said: “Healthcare professionals and other information providers need to find more effective ways to inform their patients about the importance of taking drugs as prescribed for them. People with rheumatoid arthritis need to feel empowered to keep their condition under control by having a better understanding of why their medication is less effective if they don’t take it as directed.”
The research team found potential reasons to explain patients’ behaviour. For example, patients with a positive belief in the need for the drug were more likely to take their medication as were those with fewer concerns about potential side effects. Other important factors included how patients viewed their illness. For example, patients who appreciated the chronic nature of rheumatoid arthritis, those with a better understanding of their disease and those who felt they had high levels of professional or family support were also most likely to take their drugs as prescribed.
What Causes Rheumatoid Arthritis?
Doctors don’t know the exact cause of rheumatoid arthritis. They know that with this arthritis, a person’s immune system attacks his or her own body tissues. Researchers are learning many things about why and how this happens. Things that may cause rheumatoid arthritis are:
Genes (passed from parent to child)
Senior author and director of the NIHR Manchester Musculoskeletal Biomedical Research Unit, Professor Ian Bruce said: “This is one of the first studies to assess biological adherence in rheumatoid arthritis patients over time. In the era of new and effective high-cost drugs there is the assumption that people with rheumatoid arthritis regularly take their medication as prescribed, but our findings challenge this assumption.
“We have shown that health professionals should not assume that because biologics are effective and expensive that all patients will take these as prescribed.
“Importantly we have found a number of factors and patient beliefs that help us to understand why this is happening. If we can find ways to inform, support and empower our patients better, we may also be able to improve the regularity of taking these very effective medications in this potentially disabling condition. Such an approach may be extremely cost-effective, reduce the need for further intensive treatments and reduce unnecessary wastage of expensive drugs. “
Rheumatoid arthritis affects around 400,000 people in the UK and is caused by the body’s immune system turning on itself, leading to inflammation pain and swelling in the joints and other internal organs.
The development by Arthritis Research-funded scientists of biologic drugs such as anti-TNF therapy, which block the tumour necrosis factor (TNF) pathway in the inflammatory process that causes rheumatoid arthritis has revolutionised treatment worldwide in the past 10-15 years, and transformed the lives of millions of patients.
How Is Rheumatoid Arthritis Diagnosed?
People can go to a family doctor or rheumatologist to be diagnosed. A rheumatologist is a doctor who helps people with problems in the joints, bones, and muscles. Rheumatoid arthritis can be hard to diagnose because:
There is no single test for the disease
The symptoms can be the same as other kinds of joint disease
The full symptoms can take time to develop.
To diagnose rheumatoid arthritis, doctors use medical history, physical exam, x rays, and lab tests.
Three hundred and ninety two rheumatoid arthritis patients on the British Society for Rheumatology Biologics Register, who started in the biological therapy adalimumab between 2007 and 2009, were recruited on to the study. Age, gender, psychological factors, disease activity, physical function and quality of life were also measured at baseline and at six, 12 and 18 months. Adherence was assessed at each follow-up using a patient self-completed questionnaire.
The Influence of Behavioural and Psychological Factors on Medication Adherence Over Time in Rheumatoid Arthritis Patients: A Study in the Biologics Era Catharine Morgan, John McBeth, Lis Cordingley, Kath Watson, Kimme L. Hyrich, Deborah P.M. Symmons, Ian N. Bruce is published in Rheumatology online: rheumatology.oxfordjournals.org/content/early/2015/05/12/rheumatology.kev105.full?keytype=ref&ijkey=8sIQzzepzhGS3mW
Arthritis Research UK has an extensive range of patient information on rheumatoid arthritis and other types of arthritis and musculoskeletal conditions on its website at http://www.arthritisresearchuk.org