Wednesday, 5 June 2013

Diagnosis and Compliance Mostly

My first GP always said "if it's not broke, don't fix it" so my oldest son has an odd toe that has not caused him any trouble in his whole life.  But this is the same man who I blame for the slow diagnosis of my RA, so I don't fully agree with that philosophy.  "Broke" needs a definition to be useful.

If I were as good at applying make-up as I am with eye drops and eye gel I would be stunning.
My friend says: "The worst news that I have to date, is that going forward, there are no devilishly beautiful high heels ever again, and probably not even semi-attractive flats. Can a woman nearing seventy ever find happiness again wearing orthopedic running shoes?

Answer: Yes if she can happily walk around Italy and pretend the shoes on her feet have nothing to do with her."

In a recent study of ethnically diverse and economically disadvantaged patients with rheumatoid arthritis on oral therapy, the result was that only 21% had took their DMARDS at least 80% of the time.  This led to many headlines about RA patients not being compliant and following treatment plans.

My thoughts: 
Could money have been a factor? Even if they were given medications for this study might they have decided to save some doses and make it last longer into the future.

Those with better mental health were more likely to follow directions.  

Online I read frequently about the struggles people have in reducing their prednisone use. There are a lot of well known drawbacks to prednisone that lead many to attempt to reduce their dosage.
All of these DMARDS were oral. Methotrexate by mouth has gastrointestinal side effects. I can easily imagine circumstances that would lead to a skipped or mis-timed dose.

And chiefly: Why does a study of 107 diverse and disadvantaged patients in Texas lead to generalization in online medical resources about RA patients taking medications?

Here's another study about the medication adherence in RA.  
This one is a review of literature on the topic.  
I like the concept of concordance where two people are involved in the decision.

"In the mid 1990s, the concept of ‘concordance’ was born. The term ‘concordance’ relates to a process of the consultation in which prescribing is based on partnership. In this process, healthcare professionals recognize the primacy of the patient’s decision about taking the recommended medication, and the patient’s expertise and beliefs are fully valued"


  1. Wonderful post Anet! It's so important patients understand the importance of concordance. There are other ways patients can get trusted information in regards to their medication. The local pharmacist is a wonderful resource for medication information and advice. Patients should always know and feel confident when taking medication, since it could prevent altering dosages.

  2. Thanks for the comment Lyara. It's not always easy to achieve concordance, depending on the doctor and the patient.

    I have been happy with the advice and interest of my pharmacist.