E047 I felt like I’d been given a new lease of life: Exploring the information needs and experiences of people with rheumatoid arthritis receiving bridging glucocorticoids when starting methotrexate
Authors: Logan Sarah J , Hider Samantha , Green Julie , Ryan Sarah J 
Published: April 2023

Abstract

Background/Aims
Many people diagnosed with rheumatoid arthritis (RA) receive intramuscular (IM) or oral bridging glucocorticoids whilst methotrexate (MTX) takes effect. Little is known about the information needs and experiences of people with RA receiving glucocorticoids when starting MTX.

Methods
Seventy-six 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
Nineteen participants, (11 male, 8 Female, White British, age 45-76 years, disease duration 6 weeks - 35 years) took part in telephone (n17) and video (n2) interviews (duration 34-82 minutes). Most received IM glucocorticoids (n14) before starting MTX. Three themes were identified; trusting the rheumatologist; provision of information; the benefits of glucocorticoids. Trusting the rheumatologist: Several people accepted the rheumatologist’s decision to have a glucocorticoid injection following diagnosis. Some people did not understand the purpose of the injection, and wanted information about the rationale for the injection, including how long the benefit would last and whether the injection could be repeated. Provision of information: Some people were informed by the nurse that the glucocorticoid injection should help their condition. The majority of people did not receive any written information. This left people wondering whether glucocorticoid injections could be repeated. Whereas most treated with oral glucocorticoids recalled receiving written information. Some people were issued with a steroid card. Few reported concerns about side-effects from IM glucocorticoids and did not seek information on the internet. One declined IM glucocorticoids reporting not receiving enough information to make an informed decision. Benefit of glucocorticoids: Most people reported significant benefit from glucocorticoids, experiencing relief of pain, swelling and stiffness in joints. Many found it easier to manage personal care needs and noted improved sleep and reduced levels of fatigue. This allowed many to resume their roles. Several reported that relief of symptoms gave them hope for treatment with MTX and a better quality of life with RA.

Conclusion
Treatment with IM glucocorticoids often provides rapid relief of symptoms for people with RA whilst waiting for MTX treatment to be established. Most people recalled receiving little or no information about IM glucocorticoids. Many people wanted to know the likely duration of benefit and how often they could receive IM glucocorticoids. Few people reported concerns about side-effects. Tailored information including the rationale for IM glucocorticoid treatment, duration of IM glucocorticoid treatment and RA treatment plan should be considered.
Disclosure
S.J. Logan: None. S. Hider: None. J. Green: None. S.J. Ryan: None.