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“Living a normal life”: a qualitative study of patients’ views of medication withdrawal in rheumatoid arthritis

Lookup NU author(s): Dr Ken Baker, Professor John Isaacs, Dr Ben Thompson

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Abstract

BackgroundWithdrawal of disease-modifying anti-rheumatic drugs (DMARDs) once disease remission is achieved is endorsed by current international rheumatoid arthritis (RA) management guidelines. However, very little data exists concerning patients’ views of this practice. In this qualitative study, we aimed to explore patients’ perspectives on DMARD withdrawal in the setting of established RA.MethodsIn this qualitative interview study, patients with stable established RA were recruited from rheumatology outpatient clinics at a large UK teaching hospital. The perceived advantages and disadvantages of DMARDs and views on DMARD withdrawal were explored in semi-structured interviews. Interview transcripts were analysed using standard qualitative techniques to construct an analytical framework.ResultsThirteen participants (8 female, median [IQR] age 65 [61–73]) expressed their views of DMARD treatment in the context of their “normal lives”. For some patients, disadvantages such as medication side-effects and the inconvenience of safety monitoring were sufficient hindrances to their lifestyle to justify DMARD withdrawal. However, patients who were vulnerable to loss of physical function, or who had prior experience of severe rheumatoid arthritis, expressed a strong preference against DMARD withdrawal, viewing the potential for increased pain and future disability as unacceptable risks.ConclusionsPatients view DMARD withdrawal in the context of either restoring or threatening their “normal lives”. In this model, social and personal factors play a crucial role in influencing patients’ opinions of DMARD therapy beyond a simple consideration of medication side-effects alone. A formulaic approach to DMARD withdrawal determined and imposed by clinicians would not be successful. Instead, the discussion of DMARD withdrawal should take place with the identification of patients’ priorities and in the context of their personal disease experiences.Trial registrationclinicaltrials.gov (NCT02064400), retrospectively registered 17 February 2014.


Publication metadata

Author(s): Baker KF, Isaacs JD, Thompson B

Publication type: Article

Publication status: Published

Journal: BMC Rheumatology

Year: 2019

Volume: 3

Print publication date: 13/06/2019

Online publication date: 13/06/2019

Acceptance date: 31/05/2018

Date deposited: 26/06/2019

Publisher: BioMed Central Ltd.

URL: https://doi.org/10.1186/s41927-019-0070-y

DOI: 10.1186/s41927-019-0070-y

PubMed id: 31225429


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