Patient personality may affect treatment adherence in rheumatoid arthritis

Early and aggressive management of RA is urged by investigators.
Early and aggressive management of RA is urged by investigators.

Personality traits may play a key role in patients' self-perception of rheumatoid arthritis (RA), according to a study in Rheumatology International. 

Leticia Leon, PhD, from the Hospital Clinico San Carlos, in Madrid, Spain, and colleagues examined 176 patients with RA to determine whether patient personality was associated with the acceptance or rejection of more aggressive early treatment. Eighty percent of patients were women, with a median age of 55 when disease activity began. The patients were diagnosed with RA by a rheumatologist from 2007 to 2012. A cross-sectional study was performed in Hospital Clinico San Carlos and Hospital de La Princesa where patients' sociodemographic, clinical, and therapeutic variables were recorded. 

 

Aggressive treatment, or the treatment with more than 2 disease-modifying antirheumatic drugs (DMARDs), or any biological agent, was the primary outcome. To determine the personality traits of the patients, the clinicians applied the Eysenck Personality Questionnaire, Multidimensional Health Locus of Control, Pain-Related Self-Statement Scale, and Pain-Related Control Scale to each patient. The aim was to determine whether the association between personality-related variables and aggressive treatment affected patient treatment options.

More than 75% of patients had received DMARDs in the past, and 51.1% had taken two or more DMARDs. Biologic agents were prescribed in 27% of patients. The combination of the two drug types was prescribed in 23%. As for personality variables, 50.8% of patients had high scores in extraversion, 29.5% in neuroticism, and 14.7% in psychoticism.

Aggressive treatment was less probable in patients with a high level of neuroticism. The combination of DMARD and biologic agent was 3.5 times less likely to be taken by a patient with a high level of neuroticism.

Patients with a high level of neuroticism are more worried, anxious, and/or depressed, obsessive, and hypochondriac. Thus, they may reject more aggressive therapy. Also, these patients use ineffective coping strategies, such as catastrophizing, and may be more wary of taking drugs in combination. Patients with neurotic traits are more easily influenced by external information or adverse effects or complications, which could frighten them and lead them to reject treatment, according to the authors.

“It seems that the choice of treatment in RA should be made based on both patient- and physician-related factors,” concluded the researchers. “The patient's subjective view of the disease, fears and worries may be affected by personality variables. These variables have received little attention in chronically ill patients in general and in patients with RA in particular. Emotional variables have received more attention because they are easier to modify, resulting in improved quality of life. The variables associated with the patient's personality, as studied here, are of a more permanent nature, although they are detectable. Some can even be partially modified by educating patients about their disease and the effects of available treatments.”

Reference

  1. Leon L, Redondo M, Garcia-Vadillo A, et al. Influence of patient personality in the treatment of rheumatoid arthritis. Rheumatol Int.  2016 Sep 10. doi:10.1007/s00296-016-3561-9.
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