Your commitment will make treatment for effective.
Treatment options for many chronic medical conditions have become more advanced, targeted, and effective. But these breakthroughs are only as powerful as your commitment to adhering to them. Forgetting to take your medication or skipping it because you’re feeling well that day can worsen symptoms or impact your disease progression over time.
Rheumatoid arthritis (RA) is one example of a chronic condition in which treatment compliance is a big concern for doctors. Studies have shown that treatment adherence rates could be as low as 30 percent, according to a 2012 article in the journal Expert Review of Clinical Immunology.
“Unfortunately, rheumatoid arthritis is a chronic condition,” says Ashira Blazer, MD, rheumatologist at NYU Langone Medical Center. “It means you have to take something to manage it over time.”
Here are the common mistakes patients make with medications for RA, according to Dr. Blazer.
1. You stop taking meds when you’re feeling better.
Because the symptoms of RA naturally dip and flare over time, patients may think their condition has gone away and take their medications less strictly. “Many people feel that they may be cured or maybe it will never come back,” says Dr. Blazer, “and they stop taking their medications.”
But a medication regimen for RA is not like simply taking ibuprofen for a headache. Just because the pain is gone doesn’t mean you can ditch the pills. Whether or not you’re experiencing symptoms, inflammatory disease activity is still occurring behind the scenes.
“Sometimes there’s inflammation that’s ongoing that you don’t know about,” says Dr. Blazer. “It’s damaging your joints or it’s making you more likely to develop cardiovascular disease.”
And then, of course, you’re putting yourself at risk for a future RA flare-up. Keeping disease activity low is much easier than having a flare and trying to get the disease back under control. (Here are other habits that make RA flares worse.)
2. You take steroids long term.
When cortisone was introduced as a treatment for rheumatoid arthritis in 1949, it was considered a “miracle drug” to target inflammation, according to the Arthritis Foundation (AF). But corticosteroids, also called glucocorticoids, are good for certain circumstances but not others.
“Steroids tend to make patients feel better quickly,” says Dr. Blazer. “A lot of patients have just a stock at them at home … and when they feel badly they’ll take some steroids.”
The problem with taking steroids for RA for extended periods of time is that they can cause side effects, including raising blood glucose levels, thinning the bones, and increasing risk of obesity and heart disease, according to Dr. Blazer.
Instead, patients should prioritize a disease-modifying antirheumatic drug (DMARD), and supplement with steroids when necessary, according to the Arthritis Foundation.
3. You worry more about drug side effects than RA itself.
Medication side effects are a big issue for patients of any chronic condition, and RA is no exception. Remember: managing a chronic condition isn’t just about reducing symptoms, but also keeping disease activity low to maintain a healthy body for decades to come.
DMARDs, of course, can have side effects too, such as nausea, sore mouth, decreased appetite, or heartburn, according to UpToDate from Wolters Kluwer; some drugs can cause serious issues such as liver damage, high blood pressure, and low white blood cell counts. Your doctor will likely monitor your BP and kidney function while you’re on the medication to make sure you’re getting optimal treatment results.
However, these side effects are less serious than the consequences of not managing the inflammatory actions of RA. Make no mistake: Your doctor would not give you medication if she didn’t believe the benefits outweighed the risks.
Plus, different people react to different drugs in different ways. If you’re having trouble tolerating your medication side effects, don’t stop taking the drugs. Instead, talk to your doctor.
“We have very many options and new drugs are coming out every day,” says Dr. Blazer, “so we’re able to really tailor therapy to what it is that the patient needs in their lives.”
00:00:00,000 --> 00:00:02,222
00:00:02,222 --> 00:00:05,610
arthritis is a chronic condition.
00:00:05,610 --> 00:00:10,020
It means that you have to take
something to manage it over time.
00:00:10,020 --> 00:00:14,637
So generally patients will have to take
some forms of medication lifelong.
00:00:14,637 --> 00:00:18,031
00:00:18,031 --> 00:00:20,931
Compliance is a huge problem
in all auto-immune disease,
00:00:20,931 --> 00:00:23,030
especially rheumatoid arthritis.
00:00:23,030 --> 00:00:26,100
And that's because the disease
naturally ebbs and flows.
00:00:26,100 --> 00:00:28,070
You naturally have some flares and
00:00:28,070 --> 00:00:33,020
periods of decreased activity and
no one wants to feel like they're sick.
00:00:33,020 --> 00:00:36,240
So many people feel that
they may be cured or
00:00:36,240 --> 00:00:39,760
maybe it will never come back and
they stop taking their medications.
00:00:39,760 --> 00:00:41,770
This is actually a really big mistake.
00:00:41,770 --> 00:00:45,232
First, because sometimes there's
inflammation that's ongoing that you don't
00:00:45,232 --> 00:00:45,782
00:00:45,782 --> 00:00:47,378
But it's damaging your joints or
00:00:47,378 --> 00:00:51,090
it's making you more likely to
develop cardiovascular disease.
00:00:51,090 --> 00:00:56,600
Also, it's much easier to control
disease than it is to have a flare and
00:00:56,600 --> 00:00:57,840
then bring it back.
00:00:57,840 --> 00:01:03,100
So, it's very important to continue on
the medications even if you feel well.
00:01:03,100 --> 00:01:07,870
And then also, steroids tend to
make patients feel better quickly.
00:01:07,870 --> 00:01:11,560
So, a lot of patients have just
a stock of steroids at home.
00:01:11,560 --> 00:01:14,740
And they maybe don't take
their demarge as well and
00:01:14,740 --> 00:01:17,630
then when they feel badly
they'll take some steroids.
00:01:17,630 --> 00:01:21,000
This is problematic because
steroids have many side effects.
00:01:21,000 --> 00:01:25,805
So they increase the cardiovascular risk,
they raise the blood sugar,
00:01:25,805 --> 00:01:28,805
they cause obesity and
thinning of the bones.
00:01:28,805 --> 00:01:31,785
So we really don't want patients
to be taking steroids for
00:01:31,785 --> 00:01:32,955
an extended period of time.
00:01:32,955 --> 00:01:36,915
And I think patients are very
concerned with side effects.
00:01:36,915 --> 00:01:42,075
Because the immune system is the number
one defense against infections and
00:01:42,075 --> 00:01:46,645
early cancers, there are some
risks of heightened infection and
00:01:46,645 --> 00:01:48,860
a slight risk of increased cancers.
00:01:48,860 --> 00:01:51,690
Namely non melanoma skin cancers and
00:01:51,690 --> 00:01:56,330
This risk is actually quite minimal but
I think that patients tend to
00:01:56,330 --> 00:02:00,540
worry about the risks of medications more
than they worry about the risk of disease.
00:02:00,540 --> 00:02:06,085
And you know if these medication were more
risky than ongoing rheumatoid arthritis,
00:02:06,085 --> 00:02:10,095
we would never give them as physicians and
as a medical community.
00:02:10,095 --> 00:02:14,065
So I think that the concern with
putting something in your body,
00:02:14,065 --> 00:02:19,380
especially for long periods of time,
tends to weigh on patients.
00:02:19,380 --> 00:02:23,932
If a patient is concerned about
the side effects of one drug or
00:02:23,932 --> 00:02:28,590
concerned about the dosing of a drug,
just tell your doctor.
00:02:28,590 --> 00:02:32,730
We have very many options and
new drugs are coming out everyday.
00:02:32,730 --> 00:02:36,440
So we're able to really tailor
therapy to what it is that the patient
00:02:36,440 --> 00:02:37,683
needs in their lives.
Corticosteroid use in rheumatoid arthritis. Arthritis Foundation. (Acccessed on June 28, 2018 at https://www.arthritis.org/living-with-arthritis/treatments/medication/drug-types/corticosteroids/ra-corticosteroid.php.)
Patient education: disease-modifying antirheumatic drugs (DMARDs) (beyond the basics). Waltham, MA: UpToDate, 2018. (Accessed on June 28, 2018 at https://www.uptodate.com/contents/disease-modifying-antirheumatic-drugs-dmards-beyond-the-basics#H3.)
Van den Bemt BJ, Zwikker HE, van den Ende CH. Medication adherence in patients with rheumatoid arthritis: a critical appraisal of the existing literature. Expert Rev Clin Immunol. 2012 May;8(4):337-51.