Venter Gabriella, Tieu Joanna, Black Rachel, Lester Susan, Leonardo Nieves, Whittle Samuel L, Hoon Elizabeth, Barrett Claire, Rowett Debra, Buchbinder Rachelle, Hill Catherine L
The Queen Elizabeth Hospital, Woodville, South Australia, Australia, and University of Adelaide, Adelaide, South Australia, Australia.
The Queen Elizabeth Hospital, Woodville, South Australia, Australia, and University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia.
ACR Open Rheumatol. 2021 Apr;3(4):231-238. doi: 10.1002/acr2.11234. Epub 2021 Feb 20.
Prednisolone is an effective oral glucocorticoid for managing symptoms of rheumatoid arthritis (RA) but has predictable and common adverse effects. We explored patient perspectives of prednisolone use in RA.
Patients with RA registered with the Australian Rheumatology Association Database (ARAD) who had completed an ARAD questionnaire in the preceding 12 months were invited to participate in an online survey. Responses were linked to already collected respondent demographics, medication use, and patient-reported outcome measures. The Beliefs about Medicine Questionnaire (BMQ) measured patient beliefs on medication necessity and concerns. Free-text responses outlining reasons for stopping or declining prednisolone underwent thematic analysis using NVivo 12.
The survey response rate was 79.6% (804/1010), including 251 (31.2%) reporting current prednisolone use and 432 (53.7%) reporting previous use. Compared with previous users, current users were older (P = 0.0002) and had worse self-reported pain, disease activity, health-related quality of life, and function (all P < 0.001). Current users had higher BMQ scores for prednisolone-specific necessity (3.6 versus 1.7; P <0.001) and concerns (2.7 versus 2.3; P <0.001). In previous prednisolone users (n = 432), the most frequent themes identified in free-text responses for cessation were adequate disease control (30.3%), adverse effects (25.2%), and predetermined short courses (21.3%). Of respondents citing adverse effects for cessation (n = 131), weight gain (27.5%), osteoporosis (14.7%), and neuropsychiatric issues (13.8%) were most frequent.
In our cohort, patients with RA taking prednisolone believed it was necessary yet remained concerned about its use. Adequate disease control and adverse effects were important considerations for patients using prednisolone.
泼尼松龙是一种有效的口服糖皮质激素，用于治疗类风湿关节炎（RA）的症状，但有可预测的常见不良反应。我们探讨了患者对在类风湿关节炎中使用泼尼松龙的看法。
邀请在澳大利亚风湿病协会数据库（ARAD）注册且在过去12个月内完成ARAD问卷的类风湿关节炎患者参与在线调查。回答与已收集的受访者人口统计学、药物使用情况以及患者报告的结局指标相关联。药物信念问卷（BMQ）测量患者对药物必要性和担忧的信念。对概述停止或拒绝使用泼尼松龙原因的自由文本回答使用NVivo 12进行主题分析。
调查回复率为79.6%（804/1010），其中251人（31.2%）报告当前正在使用泼尼松龙，432人（53.7%）报告曾使用过。与曾使用者相比，当前使用者年龄更大（P = 0.0002），自我报告的疼痛、疾病活动度、健康相关生活质量和功能更差（所有P < 0.001）。当前使用者在泼尼松龙特定必要性（3.6对1.7；P <0.001）和担忧（2.7对2.3；P <0.001）方面的BMQ得分更高。在曾使用泼尼松龙的使用者（n = 432）中，在停止使用的自由文本回答中确定的最常见主题是疾病得到充分控制（30.3%）、不良反应（25.2%）和预定的短期疗程（21.3%）。在因不良反应而停止使用的受访者（n = 131）中，体重增加（27.5%）、骨质疏松（14.7%）和神经精神问题（13.8%）最为常见。
在我们的队列中，服用泼尼松龙的类风湿关节炎患者认为其有必要，但仍对其使用感到担忧。疾病得到充分控制和不良反应是使用泼尼松龙的患者的重要考虑因素。
