Arthritis: 1 out of 3 patients does not follow the therapies correctly

Partly out of fear of side effects, partly because there is little awareness of the possible consequences, the fact is that 1 out of 3 patients with arthritis does not follow the therapies correctly. At the root of this error which then triggers a series of negative repercussions is a lack of communication between doctor and patient. Topics that were recently addressed at the EULAR congress, the European Alliance of Associations for Rheumatology, held in Milan in June in the presence of over 12,500 rheumatologists from all over the continent.

Poor adherence to therapies

The fact that worries rheumatologists is that about 30% of patients with rheumatoid arthritis and 40% of those with psoriatic arthritis do not follow the therapy correctly, with a high risk of persistence and increase in inflammation and consequent onset of disability, as well than a significant increase in costs. Yet, today scientific research provides increasingly effective and well-tolerated therapies with an increase in the quality of life of patients and a decrease in the disabilities associated with the pathologies. “If it is not possible to cure a chronic disease, however, we are able to block its activity, thanks to multiple solutions capable of obtaining responses from patients with various characteristics”, he declares Gian Domenico Sebastiani, president of the SIR. Obviously, however, the drugs must be taken regularly and according to the indications of your doctor. Our commitment today, especially with respect to inflammatory diseases such as arthritis, which affect as many as 5 million people, is precisely towards greater patient awareness of the importance of taking medicines correctly”.

The ‘lay summaries’ on drugs

Non-adherence arises mainly from poor doctor-patient communication, which leads to often unfounded concerns in patients with respect to possible side effects and the belief that the interruption or temporary modification of therapies has no consequences on the response. “The reason for the poor adherence is linked to an incorrect understanding on the part of the patient of the importance of continuity of treatment and to fear regarding possible side effects, which, however, occur in a limited number of people and to a small extent. To solve this problem, optimizing doctor-patient communication is essential, so that the numerous benefits of the therapy and the reduced incidence of negative effects are clarified”, he declares Annamaria Iagnocco, past president Eular. And the current president of SIR adds: “Significant help can come from the lay summaries, ‘lay’ summaries on the indications for the use of drugs aimed at non-experts, useful tools for accompanying the patient in therapy”.

Increased inflammation and possible organ damage

Non-adherence not only has direct and immediate consequences on quality of life, but can cause persistence of inflammation and, in the long run, even severe disability. “Several studies – he adds Annamaria Iagnocco, past president Eular – have shown how the incorrect intake of drugs, with methods and times different from those indicated by the doctor, with voluntary interruptions or reduced doses, significantly reduces the response. To prevent the evolution of arthritis towards joint destruction and the consequent disability, the therapeutic target is the rapid achievement of remission or, at least, a low disease activity. It is important to remember that these pathologies, if active, usually also cause organ involvement, with involvement of the cardiovascular, pulmonary and gastrointestinal systems, as well as the skin or eye, just to name a few examples. A significant role in communication with the patient can be played by dedicated nurses and health professionals, so that they too can make the indications and limits of the various therapies understood”.

The new Jak inhibitor drugs

At the center of the rheumatological debate is also the positioning of the new Jak inhibitor drugs, modified following the Oral-Balance study published in the New England Journal of Medicine last year which questioned their tolerability. “Indicated for the treatment of rheumatoid arthritis, in some cases of psoriatic arthritis and spondyloarthritis and also for non-rheumatic inflammatory bowel disease and atopic dermatitis – clarifies Carlomaurizio Montecucco, president of the Italian Foundation for Arthritis Research (FIRA) – these drugs have proven to be very effective, but the study showed an increased cardiovascular risk. A note from AIFA has therefore limited its use only to patients who do not have cardiovascular problems and for those who are refractory to all other drugs. In reality, the data emerging from clinical practice and from American and European real life studies is that this increased risk is not evident, except in people with previous pathologies or in very old age. These are innovative drugs, the use of which, in the correct times and ways, can significantly improve the quality of life of patients”.