Session Information
Date: Monday, November 6, 2017
Title: Spondyloarthropathies and Psoriatic Arthritis – Clinical Aspects and Treatment Poster II
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Medications used in the treatment of spondyloarthritis (SpA) include nonsteroidal anti-inflammatory drugs (NSAIDs) and biologics, with each class having distinct characteristics that patients may consider. Qualitative research in rheumatoid arthritis (RA) and psoriasis has shown that patients place highest value on medications that improve pain and function, have low risk of adverse events, and can be administered at home. Little data exist on SpA patient preferences regarding medications characteristics.
Methods: Through a review of records from an urban academic arthritis clinic, adult patients with ankylosing spondylitis or psoriatic arthritis were invited to participate in one of four focus group sessions. Participants were required to have been prescribed either an NSAID or biologic medication within the past year and to speak English fluently. Literature in RA/psoriasis and a SpA expert informed development of a facilitator script with questions to address SpA symptoms, medication efficacy and side effects, cost/availability and other concerns. During each 2-hour session, a trained facilitator guided patients through a semi-structured interview with the following four questions: (1) “What made you decide to start treatment for your arthritis condition?”, (2) “What about your medication made you hesitant to take it?”, (3) “Do you wish you were taking another type of medication for your condition, and if so, why?”, and (4) “Are you glad to be taking your current medication, and if so, why?” Audio recordings were transcribed and coded by two coders using an inductive reasoning approach to identify themes (NVIVO11 software).
Results: Sixteen SpA patients participated in one of the focus group sessions. The median age was 52 (range 23-65), 50% were female, 63% had psoriatic arthritis and 75% used a TNF inhibitor. Themes are detailed in the Table , and included: control of pain and stiffness, durability of medication efficacy, preventing irreversible damage, maintenance of mobility and ability to work or fulfill social roles, avoidance of side effects, avoidance of needles, alternative treatments, and long-term affordability/access.
Conclusion: SpA patient focus groups identified some factors influencing medication preferences that were similar to RA or psoriasis patients. SpA patients expressed concern for a treatment’s ability to maintain or restore one’s occupational or social role, to avoid surgeries and prevent damage, and for long-term affordability/access to medications. This study provides insights into SpA patients’ medication preferences to guide future quantitative analyses and shared decision making in clinical care.
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Table. Selected themes and quotations from SpA focus groups on medication preferences |
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1: Reducing pain/stiffness “It hurts so bad, seems like it’s pulling my spine out of my back and I can’t walk when that happens because I be in so much pain in trying to get in bed – it’s horrible.” |
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2: Maintaining/restoring independence “I gotta live – I gotta move around, I gotta walk, I gotta go to the store, I gotta go to the bathroom, I gotta come back to the hospital…I just gotta. I need the job. I need to be able to get up, to function. It don’t have to be 90%, just let me function 70% of the day. Where I can fix something to eat, can get up and wash, go to the bathroom.” |
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3. Preventing disease progression “Well for me, I’m thinking about getting worse. You know. Because I thought that these drugs that’s what it’s supposed to do is make it so that it doesn’t get worse. But it is getting worse. I can feel it.” |
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4: Medication durability and maintained affordability/access “The [medication name], now that I’m taking it, and if it’s taken away from me, the withdrawal. After 90 days and it’s out your system, then what? You get a flare-up. What do you do then? You just run to the emergency room. You get a $500 bill. $300 for the ambulance. To drive the ambulance because you can’t get up, walk. Or take yourself to the hospital…The withdrawal of the medication already being in your system and then it’s out. Then…you go back to that pain like it never left. But it gets worse. It’s worse than it was the day that you picked up that medication. |
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5: Avoiding injections When my doctor prescribed [medication name] to me, I’m frightened of needles too, it’s my first time ever shooting myself in a needle, you know? I mean, I did heroin but I never shot up. And to inject myself every Thursday and I have to wait until the last minute and I know I gotta do it before midnight– I’ll go all the way till that last second” |
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6. Long term affordability/access “It’s something that gave me my life back four months ago- I might not be able to afford it. I get something that helps and I feel it was gonna be taken away from me…I don’t make that much money. I live by myself and I gotta do everything by myself. I don’t get welfare, I don’t get food stamps, get nothing. My job, they – you know, give you health benefits – I can’t get all those benefits! I won’t be able to eat. And before I take my medicine, I gotta eat…I just wish I didn’t have to take it ‘cause I can’t afford it.” |
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7. Concern about side effects “I had a fear when I first started taking [medication name], of the side effects. My immune system, all of those. I was afraid that I’m going to be the one person that’s going to come down with everything that could possibly go wrong. I was afraid of lymphoma. But I realized my pain and I had to do what I had to do and it all turned out well in the long run but that was my biggest fear, of the side effects” |
To cite this abstract in AMA style:
Dubreuil M, Frese C, Law S, Fraenkel L, Losina E, Neogi T. Patient Preferences in Medication for Treatment of Spondyloarthritis: A Qualitative Study [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/patient-preferences-in-medication-for-treatment-of-spondyloarthritis-a-qualitative-study/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/patient-preferences-in-medication-for-treatment-of-spondyloarthritis-a-qualitative-study/