Can treatment expectations or treatment itself in patients with arthralgia suspicious for progression to rheumatoid arthritis improve illness perceptions?

Abstract

Objectives: Negative illness perceptions(IPs) are associated with poorer disease-outcomes in rheumatoid arthritis(RA). Unfortunately, IPs are generally stable in established RA. We hypothesized that IPs, especially in the cognitive domain, are modifiable in arthralgia-at-risk of RA. We aimed to study if receiving DMARD-treatment, or the offer of DMARD-treatment associates with more positive IPs in patients with clinically-suspect-arthralgia(CSA).

Methods: The population studied were CSA-patients to which a wait-and-see approach was adopted without offering DMARD-treatment, or patients were offered DMARD-treatment via the TREAT EARLIER-trial and subsequently randomized to receive methotrexate or placebo. IP was assessed using the Brief-Illness-Perception-Questionnaire(BIPQ), covering cognitive, emotional and comprehensibility domains. The effect of DMARD-treatment on IPs over time was studied by comparing the 2-year-course of BIPQs of patients receiving methotrexate or placebo. The effect of offering DMARD-treatment was examined by comparing the BIPQs of CSA-patients in the trial with those undergoing a 'wait-and-see'-policy.

Results: In total 375 CSA-patients were studied, of which 236 of the TREAT EARLIER-trial and 139 with a wait-and-see approach. Patients who received treatment showed sustained improvements in IPs over time compared with placebo in four cognitive domains: experience of physical complaints(p= 0.040), the illness' influence on life (p= 0.001), treatment-effectiveness(p= 0.041) and disease-duration (p= 0.045). Comparison at baseline showed that CSA-patients to whom treatment was offered had more confidence in treatment (p< 0.001) and tented to have a deeper understanding of their disease (p= 0.054).

Conclusion: Both the prospect of and DMARD-treatment itself improved IPs in CSA, mainly in cognitive domains. These data suggest CSA as a suitable time period for influencing IPs', which may provide possibilities to improve disease outcomes in patients developing RA.