Sticking With Your Arthritis Treatment Plan
Taking your medicines like you’re supposed to can be tough. But it’s important.
Treating rheumatoid arthritis (RA), psoriatic arthritis (PsA) and other inflammatory forms of arthritis can be hard with all those pills, shots and trips to the doctor. Add worries about side effects and costs, and it’s easy to see why some people don’t start or stick to their medicine schedule.
Doctors find that for people with inflammatory arthritis, taking their medicine is a problem with both traditional disease-modifying antirheumatic drugs (DMARDs) and biologics. Studies find that between 35% and 85% of people with RA don’t always take their medicines as prescribed.
“With biologics one assumption has been that if you prescribe this powerful drug that’s very expensive and effective, that will make people more adherent [than with traditional DMARDs]. But this hasn’t been borne out by research,” says Ian Bruce, MD, professor of rheumatology at the University of Manchester in the UK. He published a study in 2015 in Rheumatology that looked at how well 329 people with RA stuck to their schedule of adalimumab (Humira) shots. About two-thirds did not take their shots when and how often they were supposed to.
Not taking medicines or taking them wrong can lead to disease flares and joint damage, says Maria Suarez-Almazor, MD, PhD, chief of the section of rheumatology at MD Anderson Cancer Center in Houston. “[Inflammatory forms of arthritis like] RA progress slowly, so it can be difficult for patients to realize they are damaging themselves when they stop medications,” she says.
It can also cloud the picture for doctors, says Dr. Bruce. “When people aren’t doing as well as we think they should be, we assume it’s because the drug isn’t working; oftentimes it’s because the drug isn’t being taken properly.”
What’s Going On
Reasons people give for not filling or taking medicine are mixed. The cost can be one issue, says Elizabeth Salt, PhD, assistant professor of medicine in the division of rheumatology at the University of Kentucky College of Medicine in Lexington. “Many people have large copayments, hundreds of dollars a month, and though doctor’s offices work with drug companies to get assistance, it can be a big burden.”
Other reasons people give for not taking medicine is that they don’t think the medicine is needed or they are afraid of having a bad reaction to it.
Dr. Bruce says that when people understand inflammatory arthritis is a lifelong disease that needs lifelong treatment, they are more likely to take their medicine. And if they believe the drugs will control the disease, they will take their medicine. However, some patients feel that a drug is of little value because it hasn’t made them completely symptom-free. “Sometimes we can’t get 100% pain relief, but that doesn’t mean the drug isn’t helping control symptoms and preventing joint damage,” says Dr. Suarez-Almazor.
On the flip side are people who feel so much better they don’t see a reason to keep taking the medicines. “Patients may be able to wean off medications or take lower doses, but that is a conversation they need to have with their physician. About half of people flare when they stop biologics,” says Dr. Suarez-Almazor.
Doctors will usually talk with you about side effects of arthritis medicines, but sometimes they don’t ease your fears or address your real concerns.
“People can be concerned about cancer with biologics, though large databases show they don’t increase cancer risk,” says Dr. Bruce. “Patients also worry about fertility or about effects on their appearance – hair loss and weight gain, for example – but they may not bring this up with the doctor.”
Talk To Your Doctor
Many problems you have about taking your medicine can be made better by talking about them. Nurses in your doctor’s office can explain your disease and the medicines you’ve been asked to take. They may be able to help you get discounts on your costly drugs, and they can help find ways to remind you take your medicines.
Working with your doctor to make decisions about your treatment will put you more in control. Talk about your worries with your doctor and be sure to go over the pros and cons of the medicines. Then together you can decide what’s best for you. Being part of the decision will help you stick with the decisions you made.
Dr. Suarez-Almazor agrees. “If you’re concerned a drug may not be useful or you’ve heard about a bad outcome in a friend or relative or on the Internet, bring it up with your physician,” she says. “Everything has a price … there’s always risk with the medications you take. But you might have more risks from not taking the medication, because your disease can also hurt you.”
Above all, be open about your fears. “Nowadays we have many treatment options,” she says. “If patients don’t like the medication because they feel they are having adverse effects or they don’t have the quality of life they want, there are other medications.”