{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T06:47:48Z","timestamp":1790750868091,"version":"4.1.0"},"reference-count":44,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2018,3,24]],"date-time":"2018-03-24T00:00:00Z","timestamp":1521849600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["1037162"],"award-info":[{"award-number":["1037162"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis Care &amp;amp; Research"],"published-print":{"date-parts":[[2018,4]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Nonadherence to disease\u2010modifying antirheumatic drugs (<jats:styled-content style=\"fixed-case\">DMARDS<\/jats:styled-content>) in rheumatoid arthritis (<jats:styled-content style=\"fixed-case\">RA<\/jats:styled-content>) and spondyloarthritis (SpA) results in increased disease activity and symptoms and poorer quality of life. We aimed to describe patients\u2019 attitudes and experiences of <jats:styled-content style=\"fixed-case\">DMARD<\/jats:styled-content>s in <jats:styled-content style=\"fixed-case\">RA<\/jats:styled-content> and SpA to inform strategies to improve medication adherence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Databases (<jats:styled-content style=\"fixed-case\">MEDLINE<\/jats:styled-content>, Embase, Psyc<jats:styled-content style=\"fixed-case\">INFO<\/jats:styled-content>, and <jats:styled-content style=\"fixed-case\">CINAHL<\/jats:styled-content>) were searched to January 2016. Thematic synthesis was used to analyze the findings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>From 56 studies involving 1,383 adult patients (<jats:styled-content style=\"fixed-case\">RA<\/jats:styled-content> [n = 1,149], SpA [n = 191], not specified [n = 43]), we identified 6 themes (with subthemes): intensifying disease identity (severity of sudden pharmacotherapy, signifying deteriorating health, daunting lifelong therapy), distressing uncertainties and consequences (poisoning the body, doubting efficacy, conflicting and confusing advice, prognostic uncertainty with changing treatment regimens), powerful social influences (swayed by others\u2019 experiences, partnering with physicians, maintaining roles, confidence in comprehensive and ongoing care, valuing peer support), privilege and right of access to biologic agents (expensive medications must be better, right to receive a biologic agent, fearing dispossession), maintaining control (complete ownership of decision, taking extreme risks, minimizing lifestyle intrusion), and negotiating treatment expectations (miraculous recovery, mediocre benefit, reaching the end of the line).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Patients perceive <jats:styled-content style=\"fixed-case\">DMARD<\/jats:styled-content>s as strong medications with alarming side effects that intensify their disease identity. Trust and confidence in medical care, positive experiences with <jats:styled-content style=\"fixed-case\">DMARDS<\/jats:styled-content> among other patients, and an expectation that medications will help maintain participation in life can motivate patients to use <jats:styled-content style=\"fixed-case\">DMARD<\/jats:styled-content>s. Creating a supportive environment for patients to voice their concerns may improve treatment satisfaction, adherence, and health outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acr.23329","type":"journal-article","created":{"date-parts":[[2017,7,21]],"date-time":"2017-07-21T16:18:05Z","timestamp":1500653885000},"page":"525-532","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":52,"title":["Patients\u2019 Attitudes and Experiences of Disease\u2010Modifying Antirheumatic Drugs in Rheumatoid Arthritis and Spondyloarthritis: A Qualitative Synthesis"],"prefix":"10.1002","volume":"70","author":[{"given":"Ayano","family":"Kelly","sequence":"first","affiliation":[{"name":"Canberra Rheumatology and Australian National University, Canberra Canberra Hospital, Woden Australian Capital Territory and The Children's Hospital at Westmead Westmead New South Wales 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