Monday, November 14, 2016

Room to improve rheumatoid arthritis treatment

Scimex: Medical professionals are being urged to openly discuss methotrexate for the treatment of rheumatoid arthritis (RA) to allay patient concerns and myths about its toxicity, according to the authors of a Perspective published online today in the Medical Journal of Australia.
Such concerns are informed by a range of common myths and misconceptions about the diseasemodifying anti-rheumatic drug. Rheumatologists Associate Professor Mark Arnold (Associate Dean and Head of School, University of Sydney School of rural health) and Professors Inam Haq and Jane Bleasel, (Co-Directors, Sydney University Medical Program) debunked and clarified a range of these myths and misconceptions in the MJA article.

Patients often classify methotrexate as chemotherapy, for instance, given its use alone or in combination with other cytotoxic drugs as part of a regimen for treating cancer. For inflammatory diseases affecting joints such as rheumatoid arthritis however, methotrexate is typically used in low-dose weekly oral or subcutaneous injection regimens.
The authors wrote that patient trust, engagement, adherence to treatment and outcomes could be improved through open discussions between the treating doctor and the patient.
The authors also wrote of their concern regarding nocebo effects – the “biologically implausible negative effects of active therapies” that arise from the anticipation or expectation of adverse effects – which may result in the refusal of treatment and poor patient outcomes.
“There are several methotrexate “myths” which may be held by patients and health professionals, and propagated through word of mouth, information in print or on the internet that, if not simply inaccurate, may be contextually inappropriate and may generate prominent nocebo effects,” they wrote.
“Such negative anticipation responses – the expectation of routine adverse effects – may result in objections to treatment and misinterpretation and misattribution of symptoms developing during a treatment regimen.”