Research shows that patient adherence rates to rheumatoid arthritis (RA) medications range from 30%-80%, which raises the question as to why some patients discontinue use.
Severe drug side effects, such as nausea, fatigue, hair loss, depression, and other symptoms, explain why many people quit RA treatment, but some patients simply forget to take their medication.
It is crucial for physicians to have open and honest conversations with patients about RA treatments, their side effects, and how to best use them to optimize patients’ well-being.
Over 1.3 million people in the US deal with the pain, fatigue, and weakness brought on by rheumatoid arthritis (RA). The fact that this autoimmune disease affects joints on both sides of the body sets it apart from other types of arthritis.
There are several forms of treatment for RA, including the use of nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), and other medications. Despite these many choices of therapy, research shows that patients with RA have medication adherence rates ranging from 30%-80%.
In order to get a better understanding of why adherence rates fall short—and how you can address this problem—MDLinx spoke with our rheumatology advisory board member David Ozeri, MD.
Unpleasant side effects
First and foremost, patients tend to kick their RA medication as a result of the negative side effects, Dr. Ozeri told us.
“Patients are most likely to quit treatment with DMARDs due to side effects such as nausea, fatigue, and hair loss,” he said.
DMARDs may also cause liver damage and increase the risk of infections. The same is true of biologic DMARDs, which can also increase the risk of allergic reactions and injection-site reactions.
Meanwhile, other medications, such as NSAIDs, can lead to gastrointestinal issues (like stomach ulcers).
According to Dr. Ozeri, the negative side effects associated with RA treatments are just one reason that patients may be inclined to discontinue use.
"Biologic DMARDs can also be expensive, which may lead to patients’ discontinuing treatment due to financial strain. "
— Rheumatologist David Ozeri, MD
“Additionally, some patients may be reluctant to continue treatment if they do not see improvement in their symptoms,” Dr. Ozeri added.
For some, however, the decision to take RA medications boils down to whether they remember to do so.Related: Many RA patients are resistant to DMARD therapy. Here's how to address this obstacle head-on
Some patients just forget
According to an article published by the Arthritis Foundation, one of the top obstacles that patients face in taking medication is simply remembering to do so.
Forgetting to take medication is among the top four barriers—the other three of which include procrastination, financial obstacles, and concerns related to the drugs, according to Express Scripts, which analyzed 850,000 of its members and their issues with medication adherence dating back to 2011.
Other researchers have come to similar conclusions.
One participant in a report published by Preventing Chronic Disease described the experience of forgetting to take their RA medication: “I just forget it. I don’t have any pain, so until that evening, I’m like, ‘Wait a minute, did I take my pill?’ At that point, I just wait till the next morning,” they said.
Thankfully, there are strategies you can pass along to patients in order to help them remember to take their medications.
Tips for getting patients to commit to their RA treatment
Let’s say your patient struggles to remember to take their RA medications.
There are several tools that they can use to help them remember, as noted by the Arthritis Foundation.
These tools include physical reminders, such as pill organizers, calendars, and medication charts. More tech-savvy patients might find beeping computers, smartphone apps, and text messages to be good reminders.
If your patient doesn’t have any issues remembering to take their meds, but instead struggles to withstand the drugs themselves, Dr. Ozeri recommends setting aside some time for a conversation about it.
“When a patient resists treatment, it is important to have an open and honest conversation to understand their concerns and address any misconceptions they may have about their condition or the treatment options available,” Dr. Ozeri said.
"The doctor can also explore alternative treatments or adjust the current treatment plan to better suit the patient's needs and preferences. "
— Rheumatologist David Ozeri, MD
It’s important for physicians to take into account how RA treatments may influence their patients’ quality of life—some deal with depression and anxiety as a result of their medication—and to be open to revising the treatment plan in order to achieve the best possible outcomes.
Beyond this, Dr. Ozeri suggests pursuing collaborations with other HCPs in order to provide patients with the comprehensive care they may need. Patients can be directed toward RA resources that can assist them on their healing journey. As Dr. Ozeri maintains, “Patient education and support are crucial to help patients understand their condition and treatment options, manage their symptoms, and improve their quality of life.”
What this means for you
Patients with RA may struggle to stick to their treatments for several reasons. Negative side effects from the medications, forgetfulness, and shortcomings in the provider-patient relationship may contribute to discontinuations. It is worthwhile to approach these patients with an open conversation about their issues with adherence, and, with this understanding, to do your best to devise a treatment plan that best meets the patient’s needs. Sometimes simple tips and tricks for remembering to take meds, such as pill organizers, smartphone apps, and medication charts, can get patients back on track with the treatment regimen.
This article is part of Room for Better Rheum Care, where physicians and patients share the latest research, tips, and strategies for raising treatment expectations and delivering improved care in RA, PsA, and nr-AxSpA.