Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 May 22:13:1759720X211015829.
doi: 10.1177/1759720X211015829. eCollection 2021.

Treatment expectations as a possible prognostic factor for DMARD response in rheumatoid arthritis: a prospective cohort study

Affiliations

Treatment expectations as a possible prognostic factor for DMARD response in rheumatoid arthritis: a prospective cohort study

Johanna Mucke et al. Ther Adv Musculoskelet Dis. .

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.

Keywords: DMARDs; behavior; biomarkers; patient attitude to health; quality of life; rheumatoid arthritis.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest statement: The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Flow chart of our prospective cohort study. BMQ, Beliefs About Medicines Questionnaire; ESR, erythrocyte sedimentation rate; SF-36, Short Form 36.
Figure 2.
Figure 2.
Changes in DAS28-CRP and its components from T0 to T1 after 4 months. CRP, C-reactive protein; DAS28-CRP, Disease Activity Score 28-CRP; PGA, patient global assessment; SJC, swollen joint count; TJC, tender joint count.
Figure 3.
Figure 3.
Predictive variables and relative effect sizes for ΔDAS28-CRP. AE, adverse effect; BMQ, Beliefs About Medicines Questionnaire, CRP, C-reactive protein; DAS28-CRP, Disease Activity Score 28-CRP; ESR, erythrocyte sedimentation rate; PE, patient expectation; SF-36.mhi, Short Form-36 mental health; SF-36.rolph, Short Form-36 physical role functioning.

Similar articles

Cited by

References

    1. Stoffer MA, Schoels MM, Smolen JS, et al.. Evidence for treating rheumatoid arthritis to target: results of a systematic literature search update. Ann Rheum Dis 2016; 75: 16–22. - PMC - PubMed
    1. Drosos AA, Pelechas E, Voulgari PV. Rheumatoid arthritis treatment. A back to the drawing board project or high expectations for low unmet needs? J Clin Med 2019; 8: 1237. - PMC - PubMed
    1. Kaltsonoudis E, Pelechas E, Voulgari PV, et al.. Unmet needs in the treatment of rheumatoid arthritis. An observational study and a real-life experience from a single university center. Semin Arthritis Rheum 2019; 48: 597–602. - PubMed
    1. Anderson JJ, Wells G, Verhoeven AC, et al.. Factors predicting response to treatment in rheumatoid arthritis: the importance of disease duration. Arthritis Rheum 2000; 43: 22–29. - PubMed
    1. Hyrich KL, Watson KD, Silman AJ, et al.. Predictors of response to anti-TNF-alpha therapy among patients with rheumatoid arthritis: results from the British Society for Rheumatology Biologics Register. Rheumatology (Oxford) 2006; 45: 1558–1565. - PubMed