2020 to 2022: Midlands Partnership NHS Foundation Trust – Professor Sarah Ryan

Balancing safety with treatment burden in patients with rheumatoid arthritis

The research explored patients’ and family members’ perspectives on safety monitoring for disease modifying anti-rheumatic drugs (DMARDs) and how any associated treatment burden could be minimised to optimise concordance and wellbeing. The two main themes emerging from the research related to making sense of drug monitoring and the work involved in drug monitoring. Outcomes led to practice recommendations:

a) The need for health professionals to address the potential for treatment burden when DMARD treatment is being considered to enhance the uptake of safety monitoring.
b) Patients having access to flexible appointment times and monitoring locations to reduce the amount of work patients and family members are required to do, making attendance for DMARD monitoring easier.
c) Focusing on ‘person monitoring’ rather than ‘drug monitoring’, incorporating a holistic assessment which includes the potential for treatment burden.
d) Identifying solutions, through shared decision-making, which are responsive and flexible to the individual and family members’ to enhance attendance for safety monitoring.
e) Periodic face-to-face consultations for patients and family members, in whom treatment burden is a major concern, to assess whether the work involved in attending for DMARD monitoring remains manageable. This could improve concordance with medication.

• Sarah J Ryan et al., Exploring the Treatment Burden of Disease Modifying Anti-Rheumatic Drug Monitoring in People with Rheumatoid Arthritis: A Qualitative Study with Recommendations for Practice, Rheumatology, Volume 62, Issue Supplement_2, April 2023