Positive mental attitude improves treatment adherence in rheumatoid arthritis, says two studies

Two new studies presented at the European League Against Rheumatism Annual Congress (EULAR 2016) have shed light on why so many patients with rheumatoid arthritis do not adhere to their therapy, even in the early stages of their treatment. These new insights could be used to inform strategies designed to improve treatment adherence that in turn will optimise treatment outcomes and reduce healthcare costs.

The two studies highlight that:

• Patients who experience autonomy through information seeking behaviour and have positive expectations about the course of their disease are much more likely to adhere to their treatment than those patients who feel less autonomous and become passive because of their joint pain.

• Patient anxiety on starting methotrexate therapy predicts non-response to treatment at six months, and this might partly be explained by poor adherence.

To induce disease remission, patients with early rheumatoid arthritis should adhere to their disease-modifying antirheumatic drugs (DMARDs) in the first months after diagnosis. Non-adherence to DMARDs hampers the twin targets of rheumatoid arthritis treatment: obtaining low disease activity and decreasing radiological progression.

It was found that adherence is better in patients who seek treatment information and have positive expectations. “Non-adherence has been shown to be a serious problem in the treatment of rheumatoid arthritis. The consequences of non-adherence not only affect patients’ disease activity, but also the rheumatologist’s treatment decisions, which may lead to higher health care costs,” says lead author Dr Johanna Hazes from the Erasmus Medical Centre, Rotterdam, The Netherlands. “However, it remains unknown as to why so many rheumatoid arthritis patients do not adhere to their treatment.”

To identify which early inflammatory arthritis patients are at risk for non-adherence in the first three months of treatment, a population of 259 adult patients, recently diagnosed with inflammatory arthritis and started on synthetic DMARDs, were interviewed to identify potential adherence predictors, and their adherence continuously measured using electronically monitored pill bottles.

Adherence started high, but rapidly declined over three months of follow-up. Out of 15 different factors that could potentially influence adherence, ‘information seeking’ and ‘having positive expectations about their disease’ were the only ones significantly associated with adherence. ‘Adjusting to the pain’ was associated with non-adherence.

Factors not associated with adherence included: depression; negative feelings; non-specific anxiety; disability; and responses to questions covering patients’ perceptions of the necessity for their treatment and of any potential harm (including adverse effects) from their medication.

Anxiety on beginning methotrexate treatment was thought to lead to poor adherence. “Methotrexate is the DMARD of first choice in the treatment of rheumatoid arthritis; however, response to methotrexate is highly variable,” says lead researcher Dr Suzan Verstappen of the Centre for Musculoskeletal Research, University of Manchester, UK. “Being able to predict which of our rheumatoid arthritis patients are likely to not respond would enable us to provide earlier access to alternative drugs with the hope of avoiding disease progression in some of our patients,” she adds.

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