Withdrawal of disease-modifying anti-rheumatic drugs (DMARDs) once disease remission is achieved is endorsed by current international rheumatoid arthritis (RA) management guidelines. However, very little data exists concerning patients’ views of this practice. In this qualitative study, we aimed to explore patients’ perspectives on DMARD withdrawal in the setting of established RA. In this qualitative interview study, patients with stable established RA were recruited from rheumatology outpatient clinics at a large UK teaching hospital. The perceived advantages and disadvantages of DMARDs and views on DMARD withdrawal were explored in semi-structured interviews. Interview transcripts were analysed using standard qualitative techniques to construct an analytical framework. Thirteen participants (8 female, median [IQR] age 65 [61–73]) expressed their views of DMARD treatment in the context of their “normal lives”. For some patients, disadvantages such as medication side-effects and the inconvenience of safety monitoring were sufficient hindrances to their lifestyle to justify DMARD withdrawal. However, patients who were vulnerable to loss of physical function, or who had prior experience of severe rheumatoid arthritis, expressed a strong preference against DMARD withdrawal, viewing the potential for increased pain and future disability as unacceptable risks. Patients view DMARD withdrawal in the context of either restoring or threatening their “normal lives”. In this model, social and personal factors play a crucial role in influencing patients’ opinions of DMARD therapy beyond a simple consideration of medication side-effects alone. A formulaic approach to DMARD withdrawal determined and imposed by clinicians would not be successful. Instead, the discussion of DMARD withdrawal should take place with the identification of patients’ priorities and in the context of their personal disease experiences. clinicaltrials.gov (NCT02064400), retrospectively registered 17 February 2014.

中文翻译：

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“过上正常的生活”：类风湿关节炎患者对停药看法的定性研究

当前国际类风湿性关节炎 (RA) 管理指南支持在疾病缓解后停用缓解疾病的抗风湿药物 (DMARD)。然而，关于患者对这种做法的看法的数据很少。在这项定性研究中，我们旨在探讨患者在已建立 RA 的情况下对 DMARD 戒断的看法。在这项定性访谈研究中，从英国一家大型教学医院的风湿病门诊招募了稳定的 RA 患者。在半结构化访谈中探讨了 DMARD 的感知优势和劣势以及对 DMARD 退出的看法。使用标准定性技术分析采访记录以构建分析框架。13 名参与者（8 名女性，中位数 [IQR] 年龄 65 [61-73]）在他们的“正常生活”背景下表达了他们对 DMARD 治疗的看法。对于一些患者来说，药物副作用和安全监测不便等缺点足以阻碍他们的生活方式，从而证明退出 DMARD 是合理的。然而，易受身体机能丧失的患者，或曾有过严重类风湿性关节炎经历的患者，表达了强烈反对 DMARD 撤药的倾向，认为增加疼痛和未来残疾的可能性是不可接受的风险。患者在恢复或威胁他们的“正常生活”的背景下看待 DMARD 退出。在这个模型中，社会和个人因素在影响患者对 DMARD 治疗的看法方面起着至关重要的作用，而不仅仅是单纯考虑药物副作用。由临床医生确定和实施的 DMARD 退出的公式化方法不会成功。相反，应该在确定患者的优先事项和他们个人疾病经历的背景下讨论 DMARD 撤药。Clinicaltrials.gov (NCT02064400)，2014 年 2 月 17 日回顾性注册。