Patients with osteoarthritis (OA) and rheumatoid arthritis (RA) face different treatment options and determining which ones to try can be confusing.
Two new studies published in the July 2007 issue of Arthritis & Rheumatism examined patients decisions regarding therapy for RA and glucosamine for OA and found that most RA patients are reluctant to change their treatment as long as their condition didn't worsen, and that there are discrepancies in clinical trial results for glucosamine.
Recent advances in RA treatment include multi-drug therapy with anitrheumatic drugs such as methotrexate, as well as improved tools for measuring the response to therapy. Although high-dose aggressive therapy seems to hold promise, patients decisions often do not follow this recommendation. Frederick Wolfe and Kaleb Michaud, of the National Data Bank for Rheumatic Diseases in Wichita, KS, queried over 6,000 RA patients about their acceptance and satisfaction with therapy, their willingness to change and their reasons for not changing.
They found that more than three-quarters were satisfied with their medications and almost 64 percent would not want to change therapy as long as their condition didn't get worse. Fear of loss of control over their condition and fear of side effects emerged as major concerns, and maintaining their current status, as opposed to future improvement, appeared to be a high priority for patients. Interestingly, 71 percent of those satisfied with their therapy had moderate or greater arthritis activity according to the Patient Activity Scale.These data indicate that there is an important discrepancy between declared satisfaction with therapy and measured activity and functional status, and that clinical activity is not an adequate explanation for satisfaction with therapy, the authors state.
In another study led by Steven C. Vlad of Boston University Medical Center in Boston, MA, researchers analyzed 15 double-blind, randomized, placebo-controlled trials of glucosamine for OA pain that were reported between 1980 and 2006. Glucosamine is classified as a dietary supplement in the U.S., is widely available, and appears to be safe but its efficacy is uncertain, with some trials reporting little effect and others reporting positive results.