Rheumatoid arthritis

RA patients are conflicted about prednisolone

The patient experience of prednisolone for their rheumatoid arthritis is nuanced with many patients believing it is necessary yet concerned about adverse effect, Australian research shows.

Responses to a survey from more than 800 patients on the Australian Rheumatology Association Database (ARAD), found 53.7% were previous users, 31.2% were current users and 15.0% were never users of prednisolone.

Current users of prednisolone were older and had a longer disease duration than previous users. They also reported higher levels of pain, poorer disease control, greater disability, and poorer health-related quality of life.

“There were no significant differences between current and previous prednisolone users with respect to methotrexate, biologic agents, or NSAID drug use, but current users were more likely to be taking other DMARDs compared with those with previous use (41.4% versus 33.3%; p = 0.034),” the study said.

According to a Beliefs about Medicines Questionnaire, current users had a significantly higher prednisolone-specific necessity score (3.6 v 1.7; p < 0.001) and prednisolone-specific concerns score (2.7 v 2.3; p < 0.001) when compared with previous users.

Previous users of prednisolone reported their reasons for stopping the drug included adequate disease control (30.3%), adverse effects (25.2%), prescribed short courses (21.3%), and commencement of biologics (18.1%).

“Although adequate disease control was the most commonly cited reason for stopping prednisolone, adverse effects were also a key consideration for both stopping and declining prednisolone,” the study said.

“Among those with previous prednisolone use, weight gain, osteoporosis, and neuropsychiatric issues were the most commonly cited adverse effects.”

The study authors, including senior investigators Professor Rachell Buchbinder and Professor Catherine Hill, said clinicians might commonly focus on medically serious adverse events such as hypertension.

However, patients appeared more interested in adverse events that had greater psychosocial impacts.

“Clinicians should remain mindful of these common reasons for prednisolone cessation in shared decision-making on treatment with patients,” they concluded.

“The small number of respondents who refused prednisolone without prior experience frequently cited concern about adverse effects, and further research to understand reasons for these beliefs should be explored.”

Disclosures: No potential conflicts of interest relevant to this article were reported

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