Over 1.3 million people in the US deal with the pain, fatigue, and weakness brought on by rheumatoid arthritis (RA).

Rheumatoid Arthritis. Cleveland Clinic. 2022.

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.

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.

 “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.

 

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.

Why it’s a Bad Idea to Skip Meds. Arthritis Foundation. 2023.

 

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.

Oshotse C, Zullig LL, Bosworth HB, et al. Self-efficacy and adherence behaviors in rheumatoid arthritis patients. Preventing Chronic Disease. 2018;15:180218.

 

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.

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.

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.”