SAT0645-HPR MYTHS AND MISCONCEPTION ABOUT THE ILLNESS AND CONVENTIONAL SYNTHETIC DMARDS (CSDMARDS) IN PATIENTS WITH SYSTEMIC IMMUNO-INFLAMMATORY RHEUMATIC DISEASES (SIRDS): A STUDY BY RHEUMATOLOGY NURSE COUNSELOR

Background:

Myths and misconceptions about illness and conventional disease modifying anti-rheumatic drugs directly influence adherence to the prescribed treatment. It is estimated that 30–50% of patients do not adhere to their prescribed treatment due to various reasons where the beliefs of the patients play a crucial role. At our centre we the specialist rheumatology nurse counsel the patients at every visit and try to remove their myths and negative beliefs about the disease as well as the medications.

Objectives:

•To explore the common myths and misconceptions of regarding their disease and regarding the csDMARDs.

•To assess the efficacy of counseling in allaying their unfounded fear.

Methods:

A total of 450 patients with SIRDs at least 3 times attended the rheumatology out-patient clinic on csDMARDs were enrolled to complete a questionnaire that, besides demographic information, socio-economic status, and co- morbidities, had the following questions:

1.Self reported adherence to medication

2.Misbelieves regarding food items

3.What kind of health-provider was consulted at the onset of the symptoms

4.Their belief/knowledge regarding:

A. The need for physiotherapy.

B. Life style modification requirement

C. About osteoarthritis

D. Medication requirement during remission

E. Pregnancy and DMARDs

F. The need of vaccination

G. Health hazards of smoking and alcohol use

H. Harms of discontinuing treatment when they felt well

Results:

A total of 450 patients included spondyloarthropathy 150(34%), rheumatoid arthritis 200(45.7%), psoriatic arthritis 45(10%), and others 25(5.5%).The following observations was made:

1.Self-reported adherence to medication was in 250 (55%) patients; 200(45%) patient were non-adherent to treatment

2.382/450 (85%) patients had misbelieves regarding different food items.

3.225/450(50)% of the patients were not doing regular physiotherapy they were totally dependent on medications for symptoms relief.

4.387/450 (86%) patients confused the symptoms of osteoarthritis with that of RA.

5.315/450 (70 %) patients did not feel the requirement of continuing drugs during remission.

6.135/450 (30%) patients believed that while on DMARDs they cannot contemplate pregnancy.

7.351/450(78%) patients accept the need for vaccination when staring DMARDs

8.360/450 (80%) patients aware about side effect of smoking in disease but only 40 % were able to quit.

9.273/450 (60%) patients felt that more expensive medicines e.g.bDMARDs have more effects.

10.360/450 (80%) patients believed that DMARDs were ‘steroids’ and they increased weight. On analysis one patient have more than two myths simultaneously.

Conclusion:

Increased awareness of the patient’s beliefs about medicines is needed among health care providers. We should encourage patients to express their views about medicines as well as disease in order to optimize and personalize the information process. This can stimulate concordance and adherence to medication and follow up.These myths are deeply rooted in our society, single sitting counseling is not enough, and reinforcement is needed.

References:

[1]Tom Greenhalgh. Facts about rheumatoid arthritis: 7 myths you may encounter. Rheumatology Advisor. March 28, 2019.

Acknowledgments:

no

Disclosure of Interests:

None declared

SAT0644-HPR COMPLIANCE OF BIOLOGIC DISEASES MODIFYING ANTI-RHEUMATIC DRUGS (BDMARDS) WITH SYSTEMIC IMMUNO-INFLAMMATORY RHEUMATIC DISEASES (SIRDS). AN ASSESSMENT OF PATIENTS’ ADHERENCE AND NON- ADHERENCE CONCERNS

Background:

Patients with systemic immunoinflammatory rheumatic diseases (SIRDs) are often treated with bDMARDs when the response to conventional disease-modifying antirheumatic drugs (csDMARDs) is inadequate.There are, however, concerns about non-adherence to bDMARDs among patient. The non-adherence to bDMARDs may be caused by the various factors.

Objectives:

1.The main objective of present study was to find out the cause of discontinuation of bDMARDs

2.To find out the adherence and non-adherence rate for bDMARDs.

3.To identify the factors that are modifiable.

Methods:

800patients with SIRDs prescribed bDMARDs were interviewed to find out the demographic information, their socioeconomic status,and the disease duration.Additional information gathered included the comorbidities, the time for starting bDMARDs, the route of administration of bDMARDs, beliefs and perceptions about treatment efficacy and side effects if any.This was followed by looking at the adherence of bDMARDs; if they had discontinued then efforts was made to find out the reasons for the same.

Based on these findings the patients were classified into adherent and non-adherent categories. The data were analyzed further for

1.Factors that associated with persistence of bDMARDs.

2.Factors that were associated with discontinuation of bDMARDs.

Results:

A total of 800 patients were interviewed that included patients with ankylosing spondylitis 430(52.4%), rheumatoid arthritis 300(37.7%), psoriatic arthritis 45(5.2%), and others 25 (0.7%).On analysis 610(76%) patient were compliant but 190(24%) patient had discontinued the bDMARDs on their own. On comparison of both groups

Factors that were significantly related to self-discontinuation were:

•Negative beliefs about biologics (37%)

•Cost (33%)

•Reading side-effect profile on Google search (25%)

•Other co-morbidities (6%)

Factors that were significantly related to persistence of biologic treatment were:

•Good counseling by rheumatologist and rheumatology nurse (60%)

•Faith in the treating rheumatologist (25%)

•Fear of deformities and pain(15%)

On analysis it was found that a good counseling and clarifying the doubts of the patients regarding bDMARDs before starting the treatment encourages the patient to continue the biologic treatment, especially it allays their doubts about the drug adverse effects.

Conclusion:

Despite negative beliefs and misconceptions about bDMARDs, patient non-adherence at our center is not alarming.A positive reinforcement counseling appears to be the most significant factor to overcome the negative belief of patients.The affordability of the biologic treatment however remains a limiting factor in our centre as in other parts of India.

References:

[1]Tamas Koncz,MD,Marta,Pentek,Valentin,Brodszky,Katalin Ersek,MSc,Ewaorlewska&Laszlo Gulasi Volume10,2010 –Issue9 Adherence to biologic DMARD therapies in rheumatoid arthritis

Acknowledgments:

no

Disclosure of Interests:

None declared

FRI0601-HPR IMPACT OF LIFE STYLE MODIFICATION TECHNIQUE IN SYSTEMIC SCLEROSIS (SSC) PATIENTS: A STUDY BY RHEUMATOLOGY NURSES COUNSELOR

Background:

Systemic sclerosis (SSc) is an autoimmune the disease of the connective tissue that is clinically characterized by the involvement of skin (fibrosis, contractures of the finger joints), microvascular abnormalities (Raynaud’s phenomenon and complications), gastrointestinal involvement (gastroesophageal reflux disease - GERD, the lower GI tract involvement), musculoskeletal involvement (polyarthralgia, muscle disease), and involvement of internal organs (especially lungs, heart, and kidneys). Lifestyle modification techniques could have significant impact on various aspects of the disease including early disease control, increased drug adherence, positive attitude towards life, decreased financial burden of treatment, maintaining mobility and joints range of motion, minimizing or delaying joint contractures and decreased dependency with regular physical therapy. Counselling explaining the benefits of lifestyle modification related to these aspects of daily living may make a major difference in the quality of life of the patients with SSc.

Objectives:

To assess the benefits of lifestyle modification technique in improving the quality of life in patients with SSc.

Methods:

Patients with SSc attending the Rheumatology clinic of this institution, willing to participate in the survey, were enrolled in this study. All the information including the follow-up details were recorded in a pre-designed form. Their demographic information (age, gender) and disease characteristics (diagnosis, duration, treatment) were recorded, All the patients were explained the lifestyle modifications and their benefits, reinforced at each follow-up visit using posters (visual), written lifestyle modification techniques (using printed material) to raise their awareness of how to improve several of the above manifestations of SSc.

Results:

One hundred fifty (n=150) consecutive SSc patients were included in the study. It was observed that with repeated counselling 125 (83.3 %) patients adopted the lifestyle modification technique according to the advice imparted and felt a positive benefit in their daily life. However, 25 (16.6%) could not or did not follow the imparted lifestyle change advice on a regular basis. Those who were able to modify the life-style as counselled showed the following results:

Conclusion:

The lifestyle modification techniques are important to control disease and its complications. Thus, after intense and regular counselling by the specialist rheumatology nurses on the lifestyle modification technique (83.3%) adapted the advised lifestyle modifications. The study showed the important role specialist rheumatology nurses can play in educating patients and helping them improving their quality of life.

References:

[1] Hudson M, Thombs BD, Steele R. at ell. Canadian Scleroderma Research G. QOL in patients with systemic sclerosis compared to the general population and patients with other chronic conditions. J Rheumatol. 2009;36(4):768–72.

Disclosure of Interests:

None declared

SAT0609-HPR DELPHI CONSENSUS FOR THE OPTIMAL TREATMENT & MANAGEMENT OF COMPLEX RHEUMATOID ARTHRITIS (RA) PATIENTS

Background:

A significant proportion of patients with rheumatoid arthritis (RA) have additional considerations that must be taken into account for managing their disease.1These include; co-morbidities, extra-articular manifestations and poor prognostic factors.2-5Tailored management could reduce the burden on patients, the health system and wider society.

The ‘complex’ RA patient group is ill-defined and no specific recommendations exist for their optimal management and treatment.

Objectives:

A group of UK Rheumatology experts aimed to provide a set of recommendations to support consistent and high quality management, grounded in current evidence, expert opinion and best practice.

Methods:

A steering group meeting identified priority topics associated with complex RA.

Table 1.

Topics for consensus

TopicNo. of statementsDefinition of ‘complex’ RA from a medical perspective19Definition of patient factors that may contribute to ‘complex’ RA3Outcomes for RA patients with co-morbidities and/or extra articular manifestations5Prescribing options for ‘complex’ RA8Evidence vs. best practice requirements4Burden of ‘complex’ RA4TOTAL NUMBER OF STATEMENTS43

For each topic, the group defined statements they all agreed with. Delphi methodology was used to ratify these statements with rheumatology peers.

High levels of agreement (over 70%) were achieved in the first round, the group proceeded to formulate the recommendations.

Figure 1.

Responses received (n=163)

Figure 2.

Consensus Plot (total responses n=163)

Conclusion:

These recommendations are offered:

References:

[1]Uhlig T, Moe RH, Kvien TK. The burden of disease in rheumatoid arthritis. Pharmacoeconomics 2014;32:841–51

[2]Dougados M, et al. Ann Rheum Dis 2014;73:62–68.

[3]Parodi M et al,Rheumatism, 2005, 57(3): 154-60.

[4]Young A & Koduri G. Best Pract Res Clin Rheumatol. 2007 Oct;21(5):907-27.

[5]Holroyd CR, et al. Rheumatology 2019;58:e3-e42

Acknowledgments:

Support for medical writing/editorial assistance, provided by Tim Warren at Triducive was funded by Roche Products Ltd. & Chugai Pharma Ltd. in accordance with Good Publication Practice (GPP3) guidelines (http://www.ismpp.org/gpp3).

Disclosure of Interests:

Gurdeep Dulay Grant/research support from: Educational grants to attend congress meetings/conferences from Roche, Chugai, UCB, Internis, Pfizer, Lilly, Sandoz, Consultant of: Honoraria for advisory board services from Roche, Chugai, Novartis, Speakers bureau: Speaker fees from Roche, Chugai, Novartis, Amgen, Lilly, Sandoz, Ernest Choy Grant/research support from: Amgen, Bio-Cancer, Chugai Pharma, Ferring Pharmaceuticals, Novimmune, Pfizer, Roche, UCB, Consultant of: AbbVie, Amgen, AstraZeneca, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Chelsea Therapeutics, Chugai Pharma, Daiichi Sankyo, Eli Lilly, Ferring Pharmaceuticals, GlaxoSmithKline, Hospita, Ionis, Janssen, Jazz Pharmaceuticals, MedImmune, Merck Sharp & Dohme, Merrimack Pharmaceutical, Napp, Novartis, Novimmune, ObsEva, Pfizer, R-Pharm, Regeneron Pharmaceuticals, Inc., Roche, SynAct Pharma, Sanofi Genzyme, Tonix, UCB, Speakers bureau: Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Chugai Pharma, Eli Lilly, Hospira, Merck Sharp & Dohme, Novartis, Pfizer, Regeneron Pharmaceuticals, Inc., Roche, Sanofi-Aventis, UCB, Theresa Barnes Consultant of: Ad boards for Roche, Actelion and Abbvie, Speakers bureau: Speaker for MSD, UCB, Pfizer, Abbvie, Actelion, Roche and BMS, Debbie Chagadama Consultant of: Roche, Chugai, BI, Speakers bureau: Roche, Chugai, BI, Zoe Cole Consultant of: Consultancy work for Roche, Lilly, Gilead, Abbvie, Pfizer, UCB, Speakers bureau: Lilly, BMS, Abbvie, Pfizer, UCB, Janssen, Anshuman Malaviya Consultant of: Roche, Chugai, MSD, Pfizer, Novartis, Lily, BMS, Speakers bureau: Roche, BMS, Pfizer, MSD, Sandra Robinson Consultant of: Eli Lilly for Education Nurse Meeting, David Walker Grant/research support from: Gilead, Consultant of: Gilead, Lilly, Pfizer, Roche, Speakers bureau: Lilly, Pfizer, Roche, Chris Daly Employee of: Roche, Nicola Savill Employee of: Roche, Tim Warren Consultant of: Roche, Employee of: AstraZeneca, Nick Williams Shareholder of: MSD, Consultant of: Roche, Employee of: MSD