Resistance of rheumatoid arthritis patients to changing therapy: discordance between disease activity and patients' treatment choices.

OBJECTIVE: Despite advances in rheumatoid arthritis (RA) treatment, patients' decisions regarding therapy often deviate from expert recommendation. This study was undertaken to investigate patients' acceptance and satisfaction with therapy, willingness to change therapy, and reasons for not changing.
METHODS: Participants (n = 6,135) completed an 11-item questionnaire concerning treatment preferences. Eight questions assessed reasons for not wanting to change therapy. The contribution of individual predictors was determined by logistic regression analysis.
RESULTS: Questionnaire responses showed that 63.8% of the patients would not want to change therapy as long as their condition didn't get worse; 77.3% were satisfied with their medications, while 9.4% were dissatisfied. These assessments were weakly related to RA activity and functional status. Side effects had occurred in 22.4% of the patients during the previous 6 months, and in 65.5% at some period during their lifetime. Predictors of unwillingness to change therapy were satisfaction with RA control, which had an odds ratio (OR) of 6.8 (95% confidence interval [95% CI] 5.8-8.0), risk of side effects (OR 4.4 [95% CI 3.8-5.2]), physician opinion (OR 1.9 [95% CI 1.6-2.2]), fear of loss of control (OR 1.8 [95% CI 1.6-2.1]), lack of better medications (OR 1.4 [95% CI 1.2-1.6]), and costs (OR 1.3 [95% CI 1.1-1.6]). There was little difference in results between patients who were receiving biologic agents and those who were not.
CONCLUSION: There is substantial discrepancy between declared satisfaction with therapy and measured RA activity and functional status. Most RA patients are satisfied with their therapy, even many with abnormal scores. Fear of loss of control of RA and fear of side effects are major patient concerns. Maintenance of current status, rather than future improvement, appears to be a high priority for patients.