Background/Purpose: We examined the relationship between the difficulty rheumatoid arthritis (RA) patients have being able to afford their arthritis medications and illness intrusiveness. Illness intrusiveness reflects the extent to which an illness interferes with daily activities, including both instrumental activities and interpersonal relationships.

Methods: Participants (n=300) with physician-diagnosed RA and moderate/severe disease activity were recruited to participate in a longitudinal study. Data were collected via online questionnaires. At baseline, participants were asked if they had difficulty affording their RA medications (no trouble, a little trouble, a lot of trouble) and illness intrusiveness and self-efficacy were assessed using standardized questionnaires. The illness intrusiveness and self-efficacy measures were re-administered at a 6-month follow-up. We used a 13-item illness intrusiveness scale; participants were asked how their illness and/or its treatment interfere with different aspects of their lives ranging from 0 (not very much) to 100 (very much). To measure self-efficacy participants were asked how certain they were that they can manage their disease independently. Responses are scored from 0 (very uncertain) to 100 (very certain). Data were analyzed using linear regression.

Results: At baseline, controlling for education, race, and gender, participants who reported no trouble being able to afford the medications they need to control their RA, reported less illness intrusion than participants who reported having either a little or a lot of trouble (adjusted means=44.1, 51.8, and 57.7, p < 0.0001). At the 6-month follow-up, controlling for illness intrusion at baseline, education, race and gender, participants who had reported no trouble being able to afford their RA medications at baseline, reported less illness intrusion than participants who had reported having a lot of trouble (adjusted means=46.8 and 55.9, respectively, p=0.02). Participants who had reported having a little trouble fell between the other two groups (adjusted mean=48.5) and differed only from those who had reported having a lot of trouble (p=0.06). In exploratory analyses, we found that the relationship between trouble affording one’s medications and illness intrusiveness appears to be mediated by self-efficacy. At the 6-month follow-up, controlling for self-efficacy at baseline, education, race, and gender, participants who reported no trouble being able to afford their RA medications had greater self-efficacy than participants who had reported having either a little or a lot of trouble (adjusted means=53.7, 43.7, 35.1, p < 0.0001). After controlling for self-efficacy at the 6-month follow-up, the relationship between trouble affording ones medications and illness intrusiveness was no longer statistically significant (p=0.36).

Conclusion: Financial barriers that limit access to the medications needed to control one’s disease may have a deleterious effect on patient self-efficacy and contribute to lifestyle disruptions experienced by people with RA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-relationship-between-difficulty-affording-arthritis-medications-and-illness-intrusiveness-in-rheumatoid-arthritis-patients-a-longitudinal-study/