ATTITUDES TOWARDS MEDICATIONS AND COMMONLY REPORTED SIDE EFFECTS TO DMARDS IN RHEUMATOID ARTHRITIS PATIENTS ATTENDING A TERTIARY CARE HOSPITAL IN SRI LANKA

BackgroundRheumatoid arthritis(RA) is a chronic multisystem disease which can be controlled with disease modifying anti-rheumatic drugs (DMARDs). Compliance to treatment can be affected by attitudes to medicines and side effects of drugs.ObjectivesTo identify attitudes towards medicines in patients with rheumatoid arthritis and its relationship to disease characteristics and identify the side effect profile of commonly used DMARDs in a Sri lankan population.MethodsA cross sectional study was carried out on patients attending a rheumatology clinic at National hospital of Sri Lanka between August to November 2018. Patients diagnosed with RA based on standard criteria and on DMARDS for more than 3 months were administered an interviewer administered questionnaire regarding sociodemographic and beliefs about medicines questionnaire (BMQ) assessing patients’ attitudes to the necessity of prescribed medication for controlling their disease and their concerns about potential adverse consequences of taking it. Further questions about commonly reported side effects were also asked. Data was analysed using SPSS software.Results160 patients fulfilled our inclusion criteria and the response rate was 75%. The study population consisted of 84% females with an average age of 52 years. They were predominantly Sinhalese (82 %) with a median duration of disease of 10 years (interquartile range-1.6-18.4 years). Three fourths of them were seropositive. The mean disease activity (DAS-28) was 4.03 (SD-1.29). Respondents indicated their degree of agreement with each statement in the BMQ on a five-point Likert scale, ranging from 1 = strongly disagree to 5 = strongly agree. The first ten questions specifically asked regarding arthritis medication.Table 1.Percentage agreeing or strongly agreeingNecessity scaleMy health at present depends on my arthritis medicines77.5My life would be impossible without my arthritis medication72.5Without my arthritis medication I would be very ill68.3My health in the future will depend on my arthritis medication66.7My arthritis medication protects me from becoming worse.59.2Concern scaleHaving to take arthritis medication worries me40I sometimes worry about the long-term effects of my arthritis medication62.5My arthritis medication is a mystery to me28.3My arthritis medication disrupts my life38.3I sometimes worry about becoming too dependent on my arthritis medication57.5The overall necessity scale score (mean 19.2, S.D. 3.21) was higher than the concerns scale score (mean 14.86, S.D. 3.89; P<0.01) but was not statistically significant. The overall necessity scale score was found to be significantly correlated with duration of disease (p<0.05) but not with age, sex, seropositivity or disease activity.59.2 %, 13.4 %, 8.2 %, 6.1 % of the patients were on monotherapy with Methotrexate, Leflunomide, Sulphasalazine, HCQ respectively. 12.8 % were on combination methotrexate and leflunomide and remainder were on biologics. The commonest side effects noted on methotrexate were leucopenia, loss of appetite,raised liver enzymes, oral ulcers, hair loss which were 30 %, 21 %, 8 %, 7% and 11% respectively. Patients on leflunomide reported raised BP, raised liver enzymes, loss of appetite and leucopenia in 30 %, 14 %, 8 % and 6 % respectively. Patients on both reported raised liver enzymes, leucopenia, loss of appetite in 78 %, 60 %,11 % respectively. Sulphasalazine caused anaemia,leucopenia and insomnia in 23 %, 17 %, 8 % respectively.HCQ caused pigmentation and maculopathy at 17 % and 9 % respectively.ConclusionThough a positive attitude towards their medication was seen in most patients with rheumatoid arthritis, they had concerns regarding potential long-term effects and dependency. This was found to be significantly correlated to duration of disease. Educating patients about their medication and clarifying misconceptions will improve compliance and disease outcomes. Side effects noted were similar to western population but GI side effects were notably less.Disclosure of InterestsNone declared