Side Effect Fear in Medication Choice in RA and PsA

There are powerful medications in rheumatologic disease, but for many patients they represent a side-effect tax that is not bearable.

In a study by Ogdie et al in ACR Open Rheumatology, 24 patients with rheumatoid arthritis (RA) and 25 with psoriatic arthritis (PsA) were queried to opine on the “burden” of methotrexate and tumor necrosis inhibitors (TNFi).

TNF inhibitors are drugs that help stop inflammation and are used worldwide to treat inflammatory conditions such as rheumatoid arthritis (RA), psoriatic arthritis, juvenile idiopathic arthritis, inflammatory bowel disease (Crohn’s and ulcerative colitis), ankylosing spondylitis, and psoriasis.

Methotrexate is in a class of medications called antimetabolites. Methotrexate treats psoriasis by slowing the growth of skin cells to stop scales from forming. Methotrexate may treat rheumatoid arthritis by decreasing the activity of the immune system.

Most patients on TNFi therapy experienced financial difficulty in obtaining their medications, and  those on methotrexate had medication-related side effects.

The analysis of treatment burden included treatment side effects, a key one of which is effect on daily functioning.  There’s also psychological burden, challenges with accessing therapies, financial difficulty, and family planning. 

The patients on methotrexate had more nausea, fatigue, hair loss, and hepatotoxicity.  And patients taking either methotrexate or a TNFi exhibited signs of infections.

There was also a fear of side effects irrespective of methotrexate or TNFi use. Methotrexate had a more negative impact on daily functioning due to both side effects and downtime. TNFi use was linked with more severe financial worries, greater delays in treatment, gaps in care, and missed doses. TNFi use also affected patient’s ability to work, as a function of taking time off for infusion visits.

TAKEAWAY:  The fear of side effects is noteworthy, irrespective of medication choice. Further, financial barriers to healthcare are pervasive, especially in recession times.  Many pharmaceutical firms provide support for patients with low income, but this requires work by patient and provider, of course.