Clinical Rheumatology

, Volume 33, Issue 8, pp 1155–1159 | Cite as

Drug-free holiday in patients with rheumatoid arthritis: a qualitative study to explore patients’ opinion

  • I. M. Markusse
  • G. Akdemir
  • T. W. J. Huizinga
  • C. F. Allaart
Brief Report
First Online:
Received:
Revised:
Accepted:

Abstract

Clinical trials have shown that in patients with long-standing low disease activity, tapering and/or stopping antirheumatic medication is a realistic option. The objective of this study is to explore patients’ opinion about tapering and discontinuing antirheumatic drugs. This qualitative study is based on interviews with 20 patients with rheumatoid arthritis (RA) about RA treatment and treatment discontinuation through structured interviewing. Interviews were tape-recorded, transcribed verbatim, and screened by three assessors independently for meaning units. Not only positive emotions about drug discontinuation such as hope, happiness, and relief, but also fear and disappointment were mentioned. Some patients expect that drug discontinuation will be possible in other patients and/or themselves, while others do not expect this. The concept of increase in disease activity after discontinuing medication was mentioned, and while patients expect that disease activity will decrease again after restarting medication, they expect that this will take (too much) time. Positive emotions about the option to taper and discontinue antirheumatic medication, with negative expectations is a common combination in these RA patients. In particular, patients expect that disease activity will flare and that improvement upon restarting medication will take time. Patients’ expectations and feelings should be addressed before drug tapering is attempted in a clear strategy of continued monitoring of disease activity.

Keywords

Discontinuation Patient perspective Rheumatoid arthritis Tapering Treatment 
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Notes

Disclosures

None.

Contributorship

IM and GA performed data collection. IM performed the data processing, and IM and GA drafted the manuscript. TH and CA revised the manuscript. CA designed the study. All authors read and approved the final version of the manuscript.

Funding

There was no funding for this study.

References

  1. 1.
    Tanaka Y, Takeuchi T, Mimori T et al (2010) Discontinuation of infliximab after attaining low disease activity in patients with rheumatoid arthritis: RRR (remission induction by Remicade in RA) study. Ann Rheum Dis 69(7):1286–1291PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Nawata M, Saito K, Nakayamada S, Tanaka Y (2008) Discontinuation of infliximab in rheumatoid arthritis patients in clinical remission. Mod Rheumatol 18(5):460–464PubMedCrossRefGoogle Scholar
  3. 3.
    ten Wolde S, Breedveld FC, Hermans J et al (1996) Randomised placebo-controlled study of stopping second-line drugs in rheumatoid arthritis. Lancet 347(8998):347–352PubMedCrossRefGoogle Scholar
  4. 4.
    van den Broek M, Klarenbeek NB, Dirven L et al (2011) Discontinuation of infliximab and potential predictors of persistent low disease activity in patients with early rheumatoid arthritis and disease activity score-steered therapy: subanalysis of the BeSt study. Ann Rheum Dis 70(8):1389–1394PubMedCrossRefGoogle Scholar
  5. 5.
    van der Kooij SM, Goekoop-Ruiterman YP, de Vries-Bouwstra JK et al (2009) Drug-free remission, functioning and radiographic damage after 4 years of response-driven treatment in patients with recent-onset rheumatoid arthritis. Ann Rheum Dis 68(6):914–921PubMedCrossRefGoogle Scholar
  6. 6.
    Klarenbeek NB, van der Kooij SM, Guler-Yuksel M et al (2011) Discontinuing treatment in patients with rheumatoid arthritis in sustained clinical remission: exploratory analyses from the BeSt study. Ann Rheum Dis 70(2):315–319PubMedCrossRefGoogle Scholar
  7. 7.
    Crow R, Gage H, Hampson S, Hart J, Kimber A, Thomas H (1999) The role of expectancies in the placebo effect and their use in the delivery of health care: a systematic review. Health Technol Assess 3(3):1–96PubMedGoogle Scholar
  8. 8.
    Kvale S (1996) Interviews: an introduction to qualitative research interviewing. Sage, California, USAGoogle Scholar
  9. 9.
    Jones K (2002) The turn to a narrative knowing of persons: one method explored. Nursing Times Research 8:60–71CrossRefGoogle Scholar
  10. 10.
    Francis JJ, Johnston M, Robertson C et al (2010) What is an adequate sample size? Operationalising data saturation for theory-based interview studies. Psychol Health 25(10):1229–1245PubMedCrossRefGoogle Scholar
  11. 11.
    Suter LG, Fraenkel L, Holmboe ES (2006) What factors account for referral delays for patients with suspected rheumatoid arthritis? Arthritis Rheum 55(2):300–305PubMedCrossRefGoogle Scholar
  12. 12.
    Stamm TA, Cieza A, Coenen M et al (2005) Validating the International Classification of Functioning, Disability and Health Comprehensive Core Set for rheumatoid arthritis from the patient perspective: a qualitative study. Arthritis Rheum 53(3):431–439PubMedCrossRefGoogle Scholar
  13. 13.
    Detert J, Bastian H, Listing J et al (2013) Induction therapy with adalimumab plus methotrexate for 24 weeks followed by methotrexate monotherapy up to week 48 versus methotrexate therapy alone for DMARD-naive patients with early rheumatoid arthritis: HIT HARD, an investigator-initiated study. Ann Rheum Dis 72(6):844–850PubMedCrossRefGoogle Scholar
  14. 14.
    Wolfe F, Michaud K (2007) Resistance of rheumatoid arthritis patients to changing therapy: discordance between disease activity and patients’ treatment choices. Arthritis Rheum 56(7):2135–2142PubMedCrossRefGoogle Scholar
  15. 15.
    Mugunthan K, McGuire T, Glasziou P (2011) Minimal interventions to decrease long-term use of benzodiazepines in primary care: a systematic review and meta-analysis. Br J Gen Pract 61(590):e573–e578PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Clinical Rheumatology 2014

Authors and Affiliations

  • I. M. Markusse
    • 1
  • G. Akdemir
    • 1
  • T. W. J. Huizinga
    • 1
  • C. F. Allaart
    • 1
  1. 1.Department of RheumatologyLeiden University Medical CenterLeidenThe Netherlands

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