Academic Department of Rheumatology, King's College London School of Medicine, Weston Education Centre, 10, Cutcombe Rd, London, SE5 9RJ, UK.
BMC Musculoskelet Disord. 2012 Oct 18;13:200. doi: 10.1186/1471-2474-13-200.
Combinations of disease-modifying anti-rheumatic drugs (DMARDs) are increasingly used to control active rheumatoid arthritis (RA); however there is little information about patients' perspectives, their expectations, concerns and experiences of this intensive treatment.
We interviewed a quota sample of 18 patients from a single tertiary outpatient clinic, stratified by gender, ethnicity and age, based on the outpatient clinic population. Patients with early RA (<2 years) received combined conventional DMARDs; patients with established RA (>2 years) received combined conventional DMARDs or DMARDs with biologics.
Four main themes emerged from the analytical framework: (i) patients' expectations about the combined treatment focuses mainly on physical symptoms; (ii) the impact of the treatment on quality of life varied with the new medication in both groups (iii) concerns about new interventions concentrated mainly on potential side effects; and (iv) combination therapy can be self-managed in close collaboration with clinic staff, but this requires individualised management approaches. These themes resonate with von Korff's collaborative management of chronic illness model.
To our knowledge this is the first qualitative study that examined systematically in patients with early and established RA their expectations, impact on quality of life, concerns about side effects and the management of the treatment when taking combined medication with DMARDs or DMARDs and biologics. Patients have generally positive views of combination DMARDs. Within routine practice settings, achieving medication concordance with complex combined DMARD regimens is challenging, and the concerns vary between patients; careful individual assessments are essential to successfully deliver such intensive treatment.
联合使用疾病修饰抗风湿药物（DMARDs）来控制活动期类风湿关节炎（RA）的情况越来越多；然而，关于患者的看法、他们对这种强化治疗的期望、担忧和体验的信息却很少。
我们对一家三级门诊诊所的 18 名患者进行了配额抽样访谈，根据门诊患者人群，按性别、种族和年龄进行分层。早期 RA（<2 年）患者接受联合常规 DMARDs 治疗；确诊 RA（>2 年）患者接受联合常规 DMARDs 或 DMARDs 联合生物制剂治疗。
从分析框架中出现了四个主要主题：（i）患者对联合治疗的期望主要集中在身体症状上；（ii）两组患者的生活质量都受到新药物的影响（iii）对新干预措施的担忧主要集中在潜在的副作用上；（iv）联合治疗可以在与诊所工作人员密切合作的情况下进行自我管理，但这需要个性化的管理方法。这些主题与 von Korff 的慢性疾病协同管理模式相呼应。
据我们所知，这是第一项系统地检查早期和确诊 RA 患者对联合使用 DMARDs 或 DMARDs 和生物制剂时的期望、对生活质量的影响、对副作用的担忧以及治疗管理的定性研究。患者对联合 DMARDs 的治疗普遍持积极态度。在常规实践环境中，实现复杂联合 DMARD 方案的药物一致性具有挑战性，且患者之间的担忧存在差异；为了成功提供这种强化治疗，仔细的个体化评估至关重要。
