Improving Patient Compliance in RA

Pasma A, van’t Spijker A, Hazes JMW, et al., Factors associated with adherence to pharmaceutical treatment for rheumatoid arthritis patients: A systematic review. Seminars in Arthritis and Rheumatism. 2013;43(1):18-18.

Sadick NA, Sowell NF, Frits ML., et al., A Randomized Controlled Trial of an Internal Family Systems-based Psychotherapeutic Intervention on Outcomes in Rheumatoid Arthritis: A Proof-of-Concept Study.J Rheumatol. [e-pub Aug 15, 2013] doi:10.3899/jrheum.121465

Sticking with therapy is often difficult for rheumatoid arthritis (RA) patients, who must cope with a chronic, painful, and disabling illness while taking as many as 9 medications that can have unpleasant or adverse side effects.

Studies estimate that a majority of RA patients are nonadherent to therapy; that is, they don’t follow doctor’s instructions, taking substantially less than the prescribed amount of medication. New studies provide hints as to why and suggest potential strategies for improving patient compliance.

A literature review in Seminars in Arthritis and Rheumatism finds the strongest predictor of adherence is the use of disease-modifying antirheumatic drugs (DMARDs) for 6 months prior to taking tumor necrosis factor-α (TNF-α) inhibitors. The investigators explain this link by reasoning that patients who failed on previous therapy may feel an urgency to use anti-TNF medications.

A second important factor in adherence is patients’ beliefs about the necessity of their medication, as reflected in necessity subscale scores in the Beliefs about Medicines Questionnaire (BMQ). The BMQ necessity scores also show such beliefs to have the strongest positive association with adherence to DMARDs and nonsteroidal anti-inflammatory drugs.

The review concludes that BMQ scores are potentially modifiable by improved physician communication based on the Health Belief Model (perceived disease threat and severity and importance of medication) and better doctor-patient relationships.

Additionally, a newly reported randomized clinical trial of the Internal Family Systems (IFS) psychotherapeutic method, aimed at improving disease activity scores and relieving pain by teaching patients to be mindful of their disease symptoms and their beliefs, suggests that such an approach could complement the medical management of RA. The trial, involving 39 IFS intervention patients and 40 controls, found that 9 months of group and individual meetings and therapy improved self-reported pain and function, both sustained at 1 year.