How do RA patients process DMARD information: a pilot study

Project: Research project


Rheumatoid arthritis (RA) is an incurable, systemic, autoimmune disorder affecting about 1% of the US population. Current guidelines call for the aggressive treatment of early RA with disease-modifying antirheumatic drugs (DMARDs). Although adherence to DMARDs slows the progression of joint destruction and reduces functional impairment, DMARDs also are associated with undesirable side effects, such as nausea, hair loss, and secondary infections, which can decrease patients’ willingness to fill DMARD prescriptions and adhere to DMARD therapy.
Open and honest patient-provider communication can help RA patients make informed choices about DMARD treatment. However, when patients are prescribed a DMARD, they often supplement information given by physicians with information from other sources, including the internet, family, and friends. These additional sources may provide patients with misinformation about DMARDs. In fact, approximately 80% of RA patients have been exposed to conflicting medication information, defined as contradictory information about arthritis medications provided by two or more sources. Exposure to conflicting information has been associated with greater amounts of medication-related anxiety and worse medication adherence for RA patients.
To date, no published studies have examined the effects of exposure to conflicting medication information on RA patients’ DMARD prescription-filling and adherence behaviors over time. To address this knowledge gap, we propose a longitudinal study to better understand how RA patients interpret, react to, and synthesize medication information from multiple sources to make DMARD-related decisions. The data gathered for this study will be used as preliminary data for a next-step grant in which we will design and pilot an intervention to improve patient-rheumatologist communication about DMARD medications.
Our study design involves audiotaping 50 rheumatology office visits at which RA patients are prescribed a DMARD that they have not used previously. Patients will be interviewed immediately following the office visit to assess their interpretation of DMARD information provided by the rheumatologist (Aim #1). Patients then will be interviewed one week and one month following the office visit to assess information-seeking behavior and exposure to conflicting medication information (Aim #2). Last, we will determine whether exposure to conflicting information predicts patient prescription filling behavior and medication adherence (Aim #3). In addition to gathering preliminary data, the proposed study will serve as a feasibility test, allowing us to determine patient participation and attrition rates and make necessary adjustments to recruitment procedures, the data collection protocol, and qualitative coding procedures for a larger grant to develop a patient-rheumatologist communication intervention.
Effective start/end date10/1/139/30/15


  • Arthritis Foundation


Antirheumatic Agents
Rheumatoid Arthritis
Office Visits
Drug Prescriptions
Medication Adherence
Organized Financing
Information Seeking Behavior
Patient Participation
Social Adjustment