RA may lead to multiple complications and comorbidities; such as cardiovascular, pulmonary, and neuropsychiatric diseases, infection, and malignancy. The risk of cardiovascular disease is higher by 1.5-fold to 2-fold in RA patients, due to systemic chronic inflammation of RA. According to a previous study, RA patients have two or more comorbidities on average. A recent nationwide survey in South Korea showed that the most frequent comorbidities in RA patients included hypertension (30.3%), osteoarthritis (22.6%), dyslipidemia (14.1%); diabetes mellitus (12.9%), and depression (11.2%).
The presence of comorbidities may affect the common outcome measures used specifically in RA, especially joint scores, remission and response criteria, and functional disability assessment. Furthermore, it will enhance the complexity of disease in patients; with RA, which in turn poses the risk of acquiring drug-related problems (DRPs).
DRPs are events or circumstances involving drug therapy that actually or potentially interfere with desired health outcomes. There is a high incidence of DRPs in RA patients; such as drug-drug interactions; dosing problems, drug-choice problems, and adverse reactions. The incidence of DRPs is probably higher in elderly RA patients who receive multiple drugs to treat their comorbidities; resulting in polypharmacy and complex medication regimens. High inflammatory activity and long duration of treatment for chronic RA have also shown to contribute to DRPs.
In Malaysia, there have studies done on DRPs in other diseases, including erectile dysfunction, benign prostatic hyperplasia, and diabetes mellitus. However, there has a lack of studies on DRPs in patients with RA up to now. Currently, there are very limited data on DRPs in patients with RA in Malaysia. Owing to the potentially poor prognosis and susceptibility of acquiring DRPs that may affect the quality of life; this study is crucial to provide additional data on the types and factors associated with DRPs in RA patients.
The pharmacological treatment
Therefore this retrospective study was conducted in a tertiary hospital in Malaysia. The purpose of assessing DRPs in RA patients and the factors associated with its occurrence. A total of 200 patients who had received pharmacological treatment for RA were enrolled in this study. Assessment of DRPs was based on the Pharmaceutical Network Care Europe tool version 5.01.
A total of 289 DRPs with an average of 1.5±1.0 problems per patient identified; in which 78.5% of the population had at least one DRP. The most common DRPs encountered adverse reactions (38.8%); drug interactions (33.6%), and drug-choice problems (14.5%).
Factors that had a significant association with the occurrence of DRPs polypharmacy (P=0.003), multiple comorbidities (P=0.001), hyperlipidemia (P=0.009), osteo (P=0.040); renal impairment (P=0.044). These data indicated that the prevalence of DRPs was high among RA patients. In conclusion, Early identification of types of DRPs and factors may enhance the prevention and management of RA.