Managing Treatment Burden in PsA and RA: Patients' Views on Methotrexate and TNFi Use

Researchers exploring patients' perspectives on the burden associated with methotrexate (MTX) or tumor necrosis factor inhibitor (TNFi) use in psoriatic arthritis (PsA) and rheumatoid arthritis (RA) revealed major themes related to treatment burden and suggestions for health care practitioners.  

From May 2019 to March 2020, individuals with PsA or RA who were taking MTX and/or a TNFi were randomly selected from the FORWARD database for telephone interviews. The interviews aimed to gather insights into patients' views on treatment burden and their experiences with these medications. Data saturation determined the completion of interviews, which were recorded, transcribed, and analyzed using NVivo v12.0 software with a grounded theory approach. 

The interviews involved 25 patients with PsA and 24 patients with RA, with a majority being women and having a mean age of 67 years. During the interviews, participants discussed 9 major themes related to treatment burden, including managing treatment side effects, psychological impact, hindrance in daily functioning and work participation, difficulties in accessing and administering therapies, financial challenges, and concerns related to family planning or breastfeeding.  

Patients on MTX primarily reported side effects as their main burden, whereas TNFi users faced challenges related to cost and accessing medication. PsA patients often discontinued treatment due to lack of effectiveness, while RA patients cited medication cost as the reason for discontinuation. 

“Patients experience a wide range of burden associated with treatments used for PsA and RA,” said researchers. “Health care practitioners should consider these challenges when prescribing therapy and strive toward reducing this burden by understanding patients’ concerns and needs and involving them in decision making.” 

Reference  

Ogdie A, Shaw Y, Almonte M, et al. Perspectives on treatment burden for methotrexate and tumor necrosis factor inhibitors among patients with psoriatic arthritis and rheumatoid arthritis: a qualitative study. ACR Open Rheumatology. 2023;5(4):167-172. doi:10.1002/acr2.11530