Wolfe Frederick, Michaud Kaleb
National Data Bank for Rheumatic Diseases, Wichita, Kansas 67214, USA.
Arthritis Rheum. 2007 Jul;56(7):2135-42. doi: 10.1002/art.22719.
Despite advances in rheumatoid arthritis (RA) treatment, patients' decisions regarding therapy often deviate from expert recommendation. This study was undertaken to investigate patients' acceptance and satisfaction with therapy, willingness to change therapy, and reasons for not changing.
Participants (n = 6,135) completed an 11-item questionnaire concerning treatment preferences. Eight questions assessed reasons for not wanting to change therapy. The contribution of individual predictors was determined by logistic regression analysis.
Questionnaire responses showed that 63.8% of the patients would not want to change therapy as long as their condition didn't get worse; 77.3% were satisfied with their medications, while 9.4% were dissatisfied. These assessments were weakly related to RA activity and functional status. Side effects had occurred in 22.4% of the patients during the previous 6 months, and in 65.5% at some period during their lifetime. Predictors of unwillingness to change therapy were satisfaction with RA control, which had an odds ratio (OR) of 6.8 (95% confidence interval [95% CI] 5.8-8.0), risk of side effects (OR 4.4 [95% CI 3.8-5.2]), physician opinion (OR 1.9 [95% CI 1.6-2.2]), fear of loss of control (OR 1.8 [95% CI 1.6-2.1]), lack of better medications (OR 1.4 [95% CI 1.2-1.6]), and costs (OR 1.3 [95% CI 1.1-1.6]). There was little difference in results between patients who were receiving biologic agents and those who were not.
There is substantial discrepancy between declared satisfaction with therapy and measured RA activity and functional status. Most RA patients are satisfied with their therapy, even many with abnormal scores. Fear of loss of control of RA and fear of side effects are major patient concerns. Maintenance of current status, rather than future improvement, appears to be a high priority for patients.
尽管类风湿关节炎（RA）治疗取得了进展，但患者在治疗决策上往往偏离专家建议。本研究旨在调查患者对治疗的接受度和满意度、改变治疗的意愿以及不改变治疗的原因。
参与者（n = 6135）完成了一份关于治疗偏好的11项问卷。八个问题评估了不想改变治疗的原因。通过逻辑回归分析确定个体预测因素的作用。
问卷回复显示，63.8%的患者只要病情没有恶化就不想改变治疗；77.3%的患者对其药物治疗满意，而9.4%的患者不满意。这些评估与RA活动度和功能状态的相关性较弱。在过去6个月中，22.4%的患者出现过副作用，在其一生中的某个时期有65.5%的患者出现过副作用。不愿改变治疗的预测因素包括对RA控制的满意度，比值比（OR）为6.8（95%置信区间[95%CI]5.8 - 8.0）、副作用风险（OR 4.4[95%CI 3.8 - 5.2]）、医生意见（OR 1.9[95%CI 1.6 - 2.2]）、对失去控制的恐惧（OR 1.8[95%CI 1.6 - 2.1]）、缺乏更好的药物（OR 1.4[95%CI 1.2 - 1.6]）以及费用（OR 1.3[95%CI 1.1 - 1.6]）。接受生物制剂治疗的患者和未接受生物制剂治疗的患者在结果上差异不大。
宣称的治疗满意度与测得的RA活动度和功能状态之间存在显著差异。大多数RA患者对其治疗满意，即使许多患者的评分异常。对RA失去控制的恐惧和对副作用的恐惧是患者主要关心的问题。维持现状而非未来改善似乎是患者的首要任务。
