Treatment expectations as a possible prognostic factor for DMARD response in rheumatoid arthritis: a prospective cohort study. (May 2021)

• Record Type: Journal Article
• Authors: Mucke, Johanna; Brinks, Ralph; Dimitriou, Argyri; Richter, Jutta G.; Schneider, Matthias
• Is Part Of: Therapeutic advances in musculoskeletal disease. Volume 13(2021)
• Publication Date: 2021-05
• Subjects: behavior -- biomarkers -- DMARDs -- patient attitude to health -- quality of life -- rheumatoid arthritis; Musculoskeletal system -- Diseases -- Periodicals; Musculoskeletal Diseases -- Periodicals; 616.7
• DOI: 10.1177/1759720X211015829
• Languages: English
• ISSNs: 1759-720X

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