Patient experiences and perspectives of DMARD monitoring in Australians with long-disease-duration rheumatoid arthritis and psoriatic arthritis

Morgan Witts^{1

2}, Rachelle Buchbinder³, Susan Lester^{4

5}, Jessica Stanhope^{4

6}, Vibhasha Chand³, Claire Barrett^{7

8}, Rachel J Black^{4

5

9}, Marissa Lassere^{10

11}, Lyn March^{12

13}, Paul Kubler¹⁴, Catherine L Hill^{4

5

9}, Philip C Robinson^{7

14}

Affiliations

¹ Department of Medicine, Ipswich Hospital, Ipswich, QLD, Australia. morgan.witts@health.qld.gov.au.
² Department of Medicine, The University of Queensland, Brisbane, QLD, Australia. morgan.witts@health.qld.gov.au.
³ Musculoskeletal Health and Wiser Health Care Units, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
⁴ Rheumatology Unit, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Woodville South, South Australia, Australia.
⁵ Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.
⁶ School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
⁷ Department of Medicine, The University of Queensland, Brisbane, QLD, Australia.
⁸ Department of Rheumatology, Redcliffe Hospital, Redcliffe, QLD, Australia.
⁹ Rheumatology Unit, Royal Adelaide Hospital, Central Adelaide Local Health Network, Woodville South, South Australia, Australia.
¹⁰ Department of Medicine, University of New South Wales, Sydney, NSW, Australia.
¹¹ Department of Rheumatology, St George Hospital, Kogarah, NSW, Australia.
¹² Florence and Cope Professorial Department of Rheumatology, Royal North Shore Hospital, St Leonards, NSW, Australia.
¹³ Department of Rheumatology, Institute of Bone and Joint Research at Kolling Institute, University of Sydney, Sydney, NSW, Australia.
¹⁴ Department of Rheumatology, Royal Brisbane & Women's Hospital, Herston, QLD, Australia.

PMID: 41131590
PMCID: PMC12548214
DOI: 10.1186/s41927-025-00573-0

Patient experiences and perspectives of DMARD monitoring in Australians with long-disease-duration rheumatoid arthritis and psoriatic arthritis

Morgan Witts et al. BMC Rheumatol. 2025.

. 2025 Oct 23;9(1):126.

doi: 10.1186/s41927-025-00573-0.

Authors

Affiliations

¹ Department of Medicine, Ipswich Hospital, Ipswich, QLD, Australia. morgan.witts@health.qld.gov.au.
² Department of Medicine, The University of Queensland, Brisbane, QLD, Australia. morgan.witts@health.qld.gov.au.
³ Musculoskeletal Health and Wiser Health Care Units, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
⁴ Rheumatology Unit, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Woodville South, South Australia, Australia.
⁵ Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.
⁶ School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
⁷ Department of Medicine, The University of Queensland, Brisbane, QLD, Australia.
⁸ Department of Rheumatology, Redcliffe Hospital, Redcliffe, QLD, Australia.
⁹ Rheumatology Unit, Royal Adelaide Hospital, Central Adelaide Local Health Network, Woodville South, South Australia, Australia.
¹⁰ Department of Medicine, University of New South Wales, Sydney, NSW, Australia.
¹¹ Department of Rheumatology, St George Hospital, Kogarah, NSW, Australia.
¹² Florence and Cope Professorial Department of Rheumatology, Royal North Shore Hospital, St Leonards, NSW, Australia.
¹³ Department of Rheumatology, Institute of Bone and Joint Research at Kolling Institute, University of Sydney, Sydney, NSW, Australia.
¹⁴ Department of Rheumatology, Royal Brisbane & Women's Hospital, Herston, QLD, Australia.

PMID: 41131590
PMCID: PMC12548214
DOI: 10.1186/s41927-025-00573-0

Abstract

Background: Regular laboratory testing is recommended for monitoring disease activity and adverse effects in people taking conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), yet the perspectives and experiences of patients have not been examined and may inform practice. As such, we aimed to determine the experiences and perceptions of laboratory monitoring in Australian adults using csDMARDs for rheumatoid arthritis (RA) or psoriatic arthritis (PsA).

Methods: Participants in the Australian Rheumatology Association Database who had RA or PsA were sent an online questionnaire capturing their demographics, frequency of advised and actual blood tests, barriers, benefits and whether they felt they had been given an adequate rationale for testing or felt they needed more information. Data were reported using descriptive statistics.

Results: The survey was distributed to 904 ARAD participants with RA and/or PsA with 679 responses (75.1%). A total of 451 people (348 RA, 103 PsA) fulfilled inclusion criteria. Most respondents were female (72.3%) with a mean age of 63.2 ± 10.7 years. The mean disease duration was 25.0 ± 11.7 years, and most respondents (82.5%) were taking methotrexate. Respondents reported being asked to have blood tests most frequently every 12 weeks (30.1%), followed by 4 (14.6%), 26 weeks (14.4%) and 8 (13.0%) weeks. 70.5% reported that they had their blood tests either early or on time. Most respondents (87.4%) reported that they felt the rationale for blood tests had been properly explained to them, with 19.5% reporting they would like more information. Overall, few reported perceived risks and costs, while almost all reported perceived benefits.

Conclusion: Australian adults with RA and PsA taking csDMARDs are typically adherent to the schedule of laboratory monitoring requested by their treating rheumatologists. For most respondents, they reported perceived benefits with few reporting risks or costs. These self-reported findings from a long-disease-duration cohort should be used to inform standardised national guidelines for laboratory monitoring of csDMARDs. Further research into the perceived gaps in patient understanding of the need for laboratory testing may further enhance adherence.

Supplementary Information: The online version contains supplementary material available at 10.1186/s41927-025-00573-0.

Keywords: DMARDs; Inflammatory arthritis; Monitoring; Patient perspectives; Psoriatic arthritis; Rheumatoid arthritis.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: Ethics was approved by Metro North HREC A (EC00172) (Reference: LNR/2021/QRBW/73446). Informed consent was obtained from all participants. Study outline, data usage and storage information were stated in an opening statement prior to survey commencement. A statement followed outlining that completing the survey would imply consent. ARAD has ethics approval from Monash University and the Central Adelaide Local Health Network. Consent for publication: Not required. Competing interests: The authors declare no competing interests.

Figures

**Fig. 1**
Distribution of weekly intervals comparing time asked to have a blood test and time physically having blood test (n = 451)

See this image and copyright information in PMC

References

1. Ramiro S, Sepriano A, Chatzidionysiou K, Nam JL, Smolen JS, van der Heijde D, et al. Safety of synthetic and biological dmards: a systematic literature review informing the 2016 update of the EULAR recommendations for management of rheumatoid arthritis. Ann Rheum Dis. 2017;76(6):1101–36. - DOI - PubMed
1. Walker AM, Funch D, Dreyer NA, Tolman KG, Kremer JM, Alarcón GS, et al. Determinants of serious liver disease among patients receiving low-dose methotrexate for rheumatoid arthritis. Arthritis Rheum. 1993;36(3):329–35. - DOI - PubMed
1. Schmajuk G, Miao Y, Yazdany J, Boscardin WJ, Daikh DI, Steinman MA. Identification of risk factors for elevated transaminases in methotrexate users through an electronic health record. Arthritis Care Res (Hoboken). 2014;66(8):1159–66. - DOI - PMC - PubMed
1. Rigby WFC, Lampl K, Low JM, Furst DE. Review of routine laboratory monitoring for patients with rheumatoid arthritis receiving biologic or nonbiologic DMARDs. Int J Rheumatol. 2017;2017:9614241. - DOI - PMC - PubMed
1. Smolen JS, Landewé RBM, Bergstra SA, Kerschbaumer A, Sepriano A, Aletaha D, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update. Ann Rheum Dis. 2023;82(1):3–18. - DOI - PubMed

LinkOut - more resources

Full Text Sources
- BioMed Central
- PubMed Central
Research Materials
- NCI CPTC Antibody Characterization Program
Miscellaneous
- NCI CPTAC Assay Portal

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Patient experiences and perspectives of DMARD monitoring in Australians with long-disease-duration rheumatoid arthritis and psoriatic arthritis

Affiliations

Patient experiences and perspectives of DMARD monitoring in Australians with long-disease-duration rheumatoid arthritis and psoriatic arthritis

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources

Research Materials

Miscellaneous