Elsevier

Joint Bone Spine

Volume 81, Issue 1, January 2014, Pages 64-68
Joint Bone Spine

Original article
Long-term systemic glucocorticoid therapy: Patients’ representations, prescribers’ perceptions, and treatment adherence

https://doi.org/10.1016/j.jbspin.2013.07.001Get rights and content

Abstract

Introduction

Glucocorticoids have been used since 1948 for their anti-inflammatory and structural effects in various inflammatory diseases. The optimal use of glucocorticoids remains controversial. Patients may have a number of concerns about the effects of glucocorticoids. Many factors can adversely affect treatment adherence.

Objectives

To evaluate the main adverse effects reported by patients and physicians, and to assess representations associated with glucocorticoid therapy and the underlying disease, via measurements of treatment adherence, with the goal of optimizing treatment strategies and improving patient information.

Methods

From December 2011 to May 2012, we conducted two surveys in 125 patients receiving long-term glucocorticoid therapy and followed-up at the rheumatology department of the teaching hospital in Casablanca, Morocco, and in 85 hospital physicians in various specialties, respectively.

Results

Mean glucocorticoid therapy duration was 6 years, mean maximal prescribed dosage was 44.87 mg/d, and 50.4% of the patients had inflammatory joint disease. Adverse neuropsychiatric effects were reported by 70 out of 125 (56%) patients. Weight gain was the adverse effect deemed most bothersome by the physicians, who significantly underestimated the occurrence of neuropsychiatric adverse effects (27% vs 56%, P = 0.034). Adherence was poor in 80 out of 125 (64%) patients, and 22 out of 125 (18%) patients reported episodes of treatment discontinuation.

Conclusion

Prescribers underestimate the frequency of neuropsychiatric adverse effects of long-term systemic glucocorticoid therapy. Regular follow-up visits during treatment, with collection of systemic adverse effects might improve treatment adherence.

Introduction

Glucocorticoids take pride of place in the treatment of many diseases. The estimated prevalence of systemic glucocorticoid therapy prescribed for 3 months or more is 0.2% to 0.5% in the general population [1], [2] and 1.7% in women older than 55 years of age [2]. Although the benefits of glucocorticoid therapy are well established, they come at the cost of frequent adverse effects (AEs) [3], [4]. Both the occurrence of AEs and patient concerns about possible AEs can result in poor treatment adherence. Perceptions of AEs, particularly regarding their severity and consequences, may differ between patients and physicians.

We conducted surveys among patients and specialist physicians to identify the AEs they deemed most important. Our goal was to improve patient information and, ultimately, treatment adherence based on an analysis of the survey results.

Section snippets

Study design

We conducted two cross-sectional surveys between December 2011 and May 2012. One survey included 125 consecutive outpatients or inpatients at the rheumatology department of the teaching hospital in Casablanca, Morocco. Inclusion criteria were age older than 18 years and oral glucocorticoid therapy for at least 1 month in a daily dosage of at least 5 mg. Patients were given bolus intravenous injections or intra-articular injections of glucocorticoids before the current oral glucocorticoid regimen

Results

The 85 physicians consisted of 16 (18.8%) rheumatologists, 15 dermatologists, 12 nephrologists, 10 gastroenterologists, eight interns, eight neurologists, six pulmonologists, five infectiologists, three oncologists, and two pediatricians. Table 1 reports details on the glucocorticoid treatments prescribed by these physicians. Table 2 shows the main characteristics of the 125 study patients. Among them, 66 (53%) patients adhered to the adjuvant treatments, including 52 who adhered to vitamin D

Discussion

We found high rates of glucocorticoid AEs reported by both patients and physicians. The patients underestimated the occurrence of AEs, whereas the physicians underestimated the neuropsychiatric symptoms. Our results are consistent with earlier data on the AEs of long-term glucocorticoid therapy. In addition, our finding that physicians underestimated the occurrence of neuropsychiatric symptoms is in agreement with two earlier studies [5], [6]. Endogenous and exogenous glucocorticoids exert

Disclosure of interest

The authors declare that they have no conflicts of interest concerning this article.

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