Background/Purpose:

Glucocorticoids (GCs) have well documented adverse effects. However, the absolute risk and importance of these effects have not been well documented from the perspective and experience of the patient with RA. Therefore, the objective of this study was to elicit and describe the experience (benefits and harms) that patients with RA have with the chronic use of GCs.

Methods:

We conducted a qualitative study based upon grounded theory with a special focus on the benefits and harms that patients with RA experience with the use of GCs. We used semi-structured interviews, which were transcribed verbatim and then analyzed thematically using NVivo software (v11). In addition, participants completed a questionnaire regarding their demographic information and clinical characteristics of RA (disease duration, medications) prior to the interview.

Results:

Eleven participants (9 female) were interviewed. All met either the 2010 ACR/EULAR or 1987 ACR classification criteria for RA. Ages ranged from 26-83 years with 8 participants being on GCs at the time of the interview (range 2-20mg daily of prednisone equivalent). Seven participants had a disease duration >10 years, while 6 had been on chronic GCs for >5 years. The mean RAPID3 score was 9.9 (range 0-19.3). Four themes emerged (Table). Overall, GCs had been beneficial in the control of RA symptoms such as swelling and pain. However, this had ‘come at a price’, alluding to the unintended impact of GCs, both physical and emotional, such as weight gain and anger. Further important unintended effects included recurrent infections and sweating (Figure). Additionally, there was an acknowledgement of the necessity of GC use in certain contexts due to the need to be able to function for family and work purposes. Finally, there was uncertainty over attribution of potential symptoms solely to GCs or to other DMARDs or to RA itself.

Conclusion:

Participants described significant benefits from the use of GCs to control their RA, albeit accompanied by major unintended effects, both physical and emotional, allowing for better understanding of the life impact of chronic GC use in RA. This understanding of the lived experience will be used to design future measurement tools of GC impact in order to better systematically compare GCs to other potential therapeutic options in the research setting.