Influence of patient personality in the treatment of rheumatoid arthritis.
Individualized treatment of rheumatoid arthritis (RA) based on genetic/serologic factors is increasingly accepted. Moreover, patients are more actively involved in the management of their disease. However, personality has received little attention with respect to perception of the need and adherence to treatment. Our objective was to evaluate whether patient personality was associated with the acceptance or rejection of more aggressive early treatment. We performed a cross-sectional study in two hospitals with early arthritis clinics where sociodemographic, clinical, and therapeutic variables are systematically recorded. Patients completed Eysenck Personality Questionnaire, Multidimensional Health Locus of Control, Pain-Related Self-Statement Scale and Pain-Related Control Scale. Aggressive treatment was considered if patients received more than two DMARDs or biological agents during the first year of follow-up. Multivariate logistic regression analysis was performed to determine predictors of aggressive treatment. One hundred seventy-six RA patients were included (80 % women, disease begin median age 55 years). Treatment was considered aggressive in 57.9 % of the sample. Scores were high in extraversion in 50.8 % of patients, neuroticism in 29.5 % and psychoticism in 14.7 %. Neuroticism was the only factor associated with aggressive treatment, which was less probable (p = 0.04, OR = 0.40). Neuroticism also decreased the possibility of receiving a combination of biologics and DMARDs (p = 0.04, OR = 0.28). Patients with high scores on neuroticism are more worried, obsessive and hypochondriac, leading them to reject more aggressive therapy. It is important to educate about their disease so that they will accept more aggressive approaches in clear cases of poor outcome.
Rheumatology Department, IdISSC, Hospital Clinico San Carlos, Calle Profesor Martin Lagos S/N, 28040, Madrid, Spain. lleon.hcsc@salud.madrid.org.|Universidad Camilo José Cela, Madrid, Spain. lleon.hcsc@salud.madrid.org.
Leticia
L
Leon
Universidad Camilo José Cela, Madrid, Spain.
Marta
M
Redondo
Rheumatology Department, Hospital La Princesa, IIS La Princesa, Madrid, Spain.|Universidad Autónoma, Madrid, Spain.
Alberto
A
Garcia-Vadillo
Universidad Camilo José Cela, Madrid, Spain.
Miguel A
MA
Perez-Nieto
Rheumatology Department, IdISSC, Hospital Clinico San Carlos, Calle Profesor Martin Lagos S/N, 28040, Madrid, Spain.
Luis
L
Rodriguez-Rodriguez
Rheumatology Department, IdISSC, Hospital Clinico San Carlos, Calle Profesor Martin Lagos S/N, 28040, Madrid, Spain.
Juan A
JA
Jover
Rheumatology Department, Hospital La Princesa, IIS La Princesa, Madrid, Spain.
Isidoro
I
Gonzalez-Alvaro
Rheumatology Department, IdISSC, Hospital Clinico San Carlos, Calle Profesor Martin Lagos S/N, 28040, Madrid, Spain.
Lydia
L
Abasolo
D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology*; D001688:Biological Products / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007389:Internal-External Control; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D010551:Personality; D012720:Severity of Illness Index
D018501:Antirheumatic Agents; D001688:Biological Products
Biological agents; Personality; Rheumatoid arthritis