P064 It’s a long time to wait: exploring the support needs of people with rheumatoid arthritis starting methotrexate
Authors: Logan Sarah J , Hider Samantha , Green Julie , Ryan Sarah 
Published: April 2024

Abstract

Background/Aims
Methotrexate (MTX) is recommended as initial Disease Modifying Anti-Rheumatic Drug (DMARD) therapy for people with Rheumatoid Arthritis (RA) but often takes several months to become effective. Little is known about the support needs of people with RA whilst MTX takes effect.

Methods
76 adults with RA referred for MTX counselling attending two rheumatology units in the West Midlands were invited to take part in qualitative semi-structured interviews (either by phone or video). Research partners with RA helped to develop interview topic guides. Interviews were digitally recorded, transcribed and analysed using reflexive thematic analysis.

Results
19 participants, (11 male, 8 Female, White British, age 45-75 years, disease duration (6 weeks - 35 years) took part in telephone (n = 17) and video (n = 2) interviews (duration 34-82 minutes). Three themes were identified; Concerns regarding time to effect, Learning to cope with the impact of RA, A need for support to self-manage RA. Concerns regarding time to effect: most people expressed concerns about coping with active symptoms of RA whilst waiting for MTX to take effect. Few recalled receiving information about nonpharmacological symptom management. Many experienced initial benefit following intramuscular bridging steroids, often wearing off as MTX commenced, and did not recall plans for further steroids. Conflicting advice about the use of analgesia and non-steroidal anti-inflammatory drugs (NSAIDs) to manage pain and joint stiffness sometimes created confusion. A few recollected advice to stop taking analgesia or NSAIDs when starting MTX. Several reported difficulties accessing help with symptom control and obtaining analgesia and NSAIDs in primary care. Learning to cope with the impact of RA: Participants reported limitations to physical function, restricting their independence with daily living activities with an impact on social, relational and work roles. Most, however, reported finding ways to manage these limitations. Several described negative impacts on mental health. A need for support to self-manage RA: Most identified unmet needs regarding self-management whilst waiting for MTX to take effect. Few recalled receiving education or support regarding self-management for RA. Some received leaflets regarding managing flares of RA that were seen to provide practical advice and reassurance. Several reported not reading leaflets and coping with flares without education or support. Positive support was sometimes received from relatives and others with RA, whereas few used the internet to find additional help. Rheumatology advice lines were often perceived as a useful source of support, but some people were reticent to seek help and others had concerns about delayed responses.

Conclusion
Many people with RA report unmet needs to support self-management whilst waiting for MTX to take effect. Appropriate signposting and referral to support provided by RA patient associations may offer useful solutions for some.

Disclosure
S.J. Logan: None. S. Hider: None. J. Green: None. S. Ryan: None.