Treatment expectations as a possible prognostic factor for DMARD response in rheumatoid arthritis: a prospective cohort study

Author:

Mucke Johanna1ORCID,Brinks Ralph2,Dimitriou Argyri23,Richter Jutta G.2,Schneider Matthias2

Affiliation:

1. Policlinic and Hiller Research Unit for Rheumatology, Heinrich-Heine-University, Moorenstrasse 5, Duesseldorf, 40225, Germany

2. Policlinic and Hiller Research Unit for Rheumatology, Heinrich-Heine-University Duesseldorf, Germany

3. Department for Internal Medicine, Zollikerberg Hospital, Zurich, Switzerland

Abstract

Background: The prediction of the individual’s response to disease modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis (RA) is challenging and often limited. Here we evaluated the influence of patients’ expectations towards a change in treatment with DMARD on clinical outcome in RA. Methods: One hundred patients (74 female) with RA (2010 ACR/EULAR classification criteria) and an upcoming change in DMARD treatment due to non-response or adverse effects were included. Patients’ treatment beliefs, health-related quality of life and treatment expectations were measured using the Beliefs about Medicines Questionnaire (BMQ), the Short Form 36, and self-designed questions about expectations before treatment initiation (T0), and DAS28-CRP was calculated at T0 and after 4 months (T4). Associations between patients’ beliefs and expectations and changes in DAS28-CRP (T0 to T4, ΔDAS28-CRP) were explored by regression analyses after multiple imputation. Results: A total of 99 patients were included, of whom 84 completed all questionnaires. Thirty-six percent of all variability in treatment response (ΔDAS28-CRP) was explained by expectations assessed with the questionnaires and the C-reactive protein (CRP)-value at T0. Among these, the expected improvement rate, with 10.5%, as well as the CRP-value at T0, with 10.6%, had the greatest positive effect whereas the fear of adverse effects, with 11.4%, and the BMQ.concern scale, with 9.0%, had the greatest negative impact on ΔDAS28. Conclusion: Patients’ expectations towards newly induced DMARD therapies influence clinical response and may serve as possible explanatory factors for treatment response affecting subjective and objective outcome parameters. Clinical trial registration number: DRKS00017005

Publisher

SAGE Publications

Subject

Orthopedics and Sports Medicine,Rheumatology

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