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Why Don’t You Take Your Meds? Honest Advice for Rheumatoid Arthritis Medication Adherence
Discuss RA Treatment Pros and Cons
As a rheumatologist, I do my best to educate and support my patients as they learn to manage rheumatoid arthritis. I provide perspective about what each medicine does, why they are important — now and in the future — and how a person might feel taking them, both physically and emotionally. In the office, we’ll come to an agreement about the pros and cons of initiating a specific treatment strategy.
RA Treatment Goals
Our goal is to treat symptoms that impact physical function and quality of life, while also preventing long term damage to the joints. Biologics and biosimilars have made the treatment of RA much more manageable in that regard.
Why Medication Is Not Taken
Despite the availability of good medicines, there are several reasons that medication adherence, or staying on the medication, often falls short.
Unintentional NonadherenceA medication won't work as expected if it's not taken as prescribed. Sometimes a person may misunderstand the dosing instructions; it’s vital to take medicines on a specific schedule at a specific dose. This is why it’s helpful when a person with RA has a support system at home and with them during appointments. If both the patient and their caregiver — whether a spouse, an adult child, or a friend — are listening to the dosing instructions, then they're more likely to use them correctly and on time.
Compliance as a Function of CostInsurance coverage for medication varies from patient to patient. Some people with RA have low copays or will be eligible for patient assistance programs, while others face annual high deductibles and out-of-pocket expenses. If a person thinks that a medication is excessively expensive, they may try to take it less frequently — for example, once a day as opposed to twice a day as prescribed. Another person may avoid that medication altogether. Of course, this can undermine their treatment goals.
Unfortunately, in my experience, people with RA won't always reveal that they're having trouble paying for medication, which can leave physicians confused as to why they aren’t responding to the medication. If a person cannot afford a medication, it’s important to talk about it with healthcare providers. There are many different treatments available, and a doctor and his office staff can help a patient find a treatment that is both effective and accessible.
Misperceptions About Long-Term Side EffectsPeople diagnosed with RA face decades of treatment, so it’s understandable that they might worry about whether medication will cause unexpected toxicity, perhaps in the form of infections or malignancies. As is always the case, patient education and dialogue is the core of communication and understanding. There will always be advantages and disadvantages of choosing one medication over another.
Keep Asking Questions
Every time a person with RA sees their healthcare provider, they have an opportunity to ask questions and determine if their treatment is on track to meet their personal goals. Physicians, in turn, will communicate about anything new that has been learned about existing or brand new medicines. The dialogue about treatment is ongoing.
Own Your Treatment Plan
Anyone living with a chronic disease faces a lifetime of making choices about treatment. There will be periods when they feel great, followed by painful flares. But the highs and lows of RA are better addressed when the person with RA, the healthcare providers, and the patient supporters all work together to ensure that the patient feels empowered, stays compliant with treatment, and asks questions when they arise.
Connect With Other People Who Have RA
I also urge my patients to build relationships with other people who have RA, so that they don’t feel like they're battling an illness alone. There are local support groups across the country, as well as online support and education resources, such as that found at CreakyJoints.
Jonathan Krant, MD, is medical director ofCreakyJointsand chief of medicine and chief of rheumatology at Adirondack Health in Saranac Lake, New York.
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