Canberra Rheumatology and Australian National University, Canberra, Canberra Hospital, Woden, Australian Capital Territory, and The Children's Hospital at Westmead, Westmead, New South Wales, Australia.
Canberra Rheumatology and Australian National University, Canberra, and Canberra Hospital, Woden, Australian Capital Territory, Australia.
Arthritis Care Res (Hoboken). 2018 Apr;70(4):525-532. doi: 10.1002/acr.23329. Epub 2018 Mar 24.
Nonadherence to disease-modifying antirheumatic drugs (DMARDS) in rheumatoid arthritis (RA) and spondyloarthritis (SpA) results in increased disease activity and symptoms and poorer quality of life. We aimed to describe patients' attitudes and experiences of DMARDs in RA and SpA to inform strategies to improve medication adherence.
Databases (MEDLINE, Embase, PsycINFO, and CINAHL) were searched to January 2016. Thematic synthesis was used to analyze the findings.
From 56 studies involving 1,383 adult patients (RA [n = 1,149], SpA [n = 191], not specified [n = 43]), we identified 6 themes (with subthemes): intensifying disease identity (severity of sudden pharmacotherapy, signifying deteriorating health, daunting lifelong therapy), distressing uncertainties and consequences (poisoning the body, doubting efficacy, conflicting and confusing advice, prognostic uncertainty with changing treatment regimens), powerful social influences (swayed by others' experiences, partnering with physicians, maintaining roles, confidence in comprehensive and ongoing care, valuing peer support), privilege and right of access to biologic agents (expensive medications must be better, right to receive a biologic agent, fearing dispossession), maintaining control (complete ownership of decision, taking extreme risks, minimizing lifestyle intrusion), and negotiating treatment expectations (miraculous recovery, mediocre benefit, reaching the end of the line).
Patients perceive DMARDs as strong medications with alarming side effects that intensify their disease identity. Trust and confidence in medical care, positive experiences with DMARDS among other patients, and an expectation that medications will help maintain participation in life can motivate patients to use DMARDs. Creating a supportive environment for patients to voice their concerns may improve treatment satisfaction, adherence, and health outcomes.
类风湿关节炎（RA）和脊柱关节炎（SpA）患者不遵医嘱使用疾病修正抗风湿药物（DMARDs）可导致疾病活动度和症状增加，生活质量下降。本研究旨在描述 RA 和 SpA 患者对 DMARDs 的态度和体验，为改善药物依从性提供策略。
检索 MEDLINE、Embase、PsycINFO 和 CINAHL 数据库，检索时间截至 2016 年 1 月。采用主题分析方法对结果进行分析。
共纳入 56 项研究，涉及 1383 例成年患者（RA [n=1149]、SpA [n=191]、未特指 [n=43]），确定了 6 个主题（包含亚主题）：强化疾病特征（药物治疗突然恶化，表明健康状况恶化，令人畏惧的终身治疗）、令人痛苦的不确定性和后果（毒害身体，怀疑疗效，相互矛盾和令人困惑的建议，治疗方案改变导致预后不确定）、强大的社会影响（受他人经历的影响，与医生合作，保持角色，对全面持续护理的信心，重视同伴支持）、获得生物制剂的特权和权利（昂贵的药物必须更好，有权获得生物制剂，担心失去药物）、控制感（完全拥有决策权，承担极端风险，将生活干扰最小化）、协商治疗预期（奇迹般的恢复，中等益处，达到治疗终点）。
患者认为 DMARDs 是具有严重副作用的强效药物，可强化其疾病特征。对医疗护理的信任和信心、患者之间使用 DMARDs 的积极体验以及对药物将有助于维持参与生活的期望，可激励患者使用 DMARDs。为患者提供表达担忧的支持性环境，可能会提高治疗满意度、依从性和健康结局。
