Table 4.

Disease modifying anti-rheumatic drugs (DMARDS) – Kelly & Colleagues 2017 [66]

Maintaining control	Patients wanted full information about DMARDs so that they could make their own choice. Some were prepared to accept complications and would take extreme risks.
Distressing uncertainties & consequences	Some were worried about the safety of DMARDs and were uncertain about their efficacy: ‘My orthopaedist said: “arthritis patients actually have two diseases, that is arthritis and methotrexate”; I have always remembered that.’
Negotiating treatment expectations	Emotional responses to DMARDs hinged on impact, or expected impact of medication. For some Biologic DMARDs were seen as the last hope. Some were disappointed with the effects; for others, the effects exceeded hopes.
Powerful social influences	Family, friends, doctors and nurses could have a strong influence on the decision to take DMARDS. Patients needed to have confidence in the doctor, yet experience of healthcare was variable.
Privilege and right of access to biologics	Some felt it was a privilege to take biologic DMARDS and could feel guilty. Others felt that everyone with RA had a right to be prescribed. Some were very worried about DMARDs being withdrawn and hid any side effects.
Intensifying disease identity	Some were shocked about being prescribed ‘strong’ medications and felt this was a sign of increasing disease severity. Some felt dependent on lifelong medication which made them contemplate the incurability of RA.

This table summarise the findings from Kelly and colleagues ‘Patients’ attitudes and experiences of disease-modifying anti-rheumatic drugs in rheumatoid arthritis and spondyloarthritis: A qualitative synthesis’ [66]