Rheumatoid arthritis, self-care, and pharmacological treatment: a scoping review
DOI:
https://doi.org/10.21527/2176-7114.2025.50.16251Keywords:
Rheumatoid Arthritis, Self-Care, Pharmacological Treatment, Rheumatic Diseases, NursingAbstract
Objective: To summarize the evidence on pharmacological treatment and its relationship with self-care in individuals with rheumatoid arthritis. Method: This scoping review was conducted in the first half of 2023. Articles published since 1985 were included, covering indexed journals, gray literature, and reference lists, with no language restrictions. Study selection was performed using Rayyan software, and data were extracted using a standardized questionnaire in Excel. The protocol was registered on the Open Science Framework (doi.org/10.17605/OSF.IO/H3SZK). Results: A total of 31 studies published between 1999 and 2022 were retrieved, mostly cross-sectional and published in English. The most frequently reported factors related to pharmacological treatment and changes in self-care included medication side effects, number of medications, indefinite treatment duration, self-medication, knowledge of treatment, positive treatment effects, as well as fear and negative beliefs. Conclusion: The relationship between self-care and pharmacological treatment in individuals with rheumatoid arthritis involves multiple variables. An individualized approach may facilitate the understanding of specific factors for each person and support the management of improved self-care.
References
1 Dedmon LE. The genetics of rheumatoid arthritis. Rheumatology. Oxford. 2020;59(10):2661-2670. DOI: https://doi.org/10.1093/rheumatology/keaa232
2 Roodenrijs NMT, Goes MC, Welsing PMJ, Tekstra J, Lafeber FPJG, Jacobs JWG, et al. Difficult-to-treat rheumatoid arthritis: contributing factors and burden of disease. Rheumatology. Oxford. 2021;6(8):3778-3788. DOI: https://doi.org/10.1093/rheumatology/keaa860
3 Shi G, Liao X, Lin Z, Liu W, Luo X, Zhan H, et al. Estimation of the global prevalence, incidence, years lived with disability of rheumatoid arthritis in 2019 and forecasted incidence in 2040: results from the Global Burden of Disease Study 2019. Clin Rheumatol. 2023;42(9):2297-2309. DOI: https://doi.org/10.1007/s10067-023-06628-2
4 Simões TC, Meira KC, Santos J, Câmara DCP. Prevalence of chronic diseases and access to health services in Brazil: evidence of three household surveys. Ciênc. saúde coletiva. 2021;26(09):3991-4006. DOI: https://doi.org/10.1590/1413-81232021269.02982021
5 Cush JJ. Rheumatoid Arthritis: Early Diagnosis and Treatment. Med Clin North Am. 2021;105(2):355-65. DOI: https://doi.org/10.1016/j.mcna.2020.10.006
6 Orem DE, Taylor SG. Reflections on nursing practice science: the nature, the structure, and the foundation of nursing sciences. Nurs Sci Q. 2011;24(1):35-41. DOI: https://doi.org/10.1177/0894318410389061
7 Yip JYC. Theory-Based Advanced Nursing Practice: A Practice Update on the Application of Orem's Self-Care Deficit Nursing Theory. SAGE Open Nurs. 2021;7:1-7. DOI: https://doi.org/10.1177/23779608211011993
8 Papadimitropoulos E, Brnabic A, Vorstenbosch E, Leonardi F, Moyano S, Gomez D. The burden of illness of rheumatoid arthritis in Latin America-A systematic literature review. Int J Rheum Dis. 2022;25(4):405-21. DOI: https://doi.org/10.1111/1756-185X.14295
9 Nikiphorou E, Santos EJF, Marques A, Böhm P, Bijlsma JWJ, Daien CI, et al. 2021 EULAR recommendations for the implementation of self-management strategies in patients with inflammatory arthritis. Ann Rheum Dis. 2021;80:1278-1285. DOI: http://dx.doi.org/10.1136/annrheumdis-2021-220249
10 Damgaard AJ, Primdahl J, Esbensen BA, Latocha KM, Bremander A. Self-management support needs of patients with inflammatory arthritis and the content of self-management interventions: a scoping review. Semin Arthritis Rheum. 2023;60:152203. DOI: https://doi.org/10.1016/j.semarthrit.2023.152203
11 Peters MDJ, Godfrey CM, Khalil H, McInerney P, Parker D, Soares CB. Guidance for conducting systematic scoping reviews. Int J Evid-Based Healthc. 2015;13(3):141-146. DOI: http://dx.doi.org/10.1097/XEB.0000000000000050
12 Joanna Briggs Institute. JBI Levels of Evidence [Internet]. 2013 [citado 25 ago 2023]. Disponível em: https://jbi.global/sites/default/files/2019-05/JBI-Levels-of-evidence_2014_0.pdf
13 Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for Scoping Reviews (PRISMA-ScR): checklist and Explanation. Ann Intern Med. 2018;169(7):467-473. DOI: http://dx.doi.org/10.7326/M18-0850
14 Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372(71). DOI: https://doi.org/10.1136/bmj.n71
15 Gustafsson M, Gaston-Johansson F, Aschenbrenner D, Merboth M. Pain, coping and analgesic medication usage in rheumatoid arthritis patients. Patient Educ Couns. 1999;37(1):33-41. DOI: https://doi.org/10.1016/s0738-3991(98)00100-1
16 Mishima M; Kunimoto, H; Yamasaki, K. A Survey on Self-Care of Rheumatoid Arthritis Patients. Shimane University Izumo Campus Bulletin. 1999;4:19-26. Disponível em: http://id.nii.ac.jp/1377/00000051/
17 Magnusson CJ. The meaning of self-care for women with rheumatoid arthritis. Canada: The University of British Columbia; 2002 [citado 20 maio 2023]. Disponível em: https://open.library.ubc.ca/media/stream/pdf/831/1.0055974/2
18 Carder PC, Vuckovic N, Green CA. Negotiating medications: patient perceptions of long-term medication use. J Clin Pharm Ther. 2003;28(5):409-417. DOI: https://doi.org/10.1046/j.0269-4727.2003.00511.x
19 Ahlmén M, Nordenskiöld U, Archenholtz B, Thyberg I, Rönnqvist R, Lindén L, et al. Rheumatology outcomes: the patient's perspective. A multicentre focus group interview study of Swedish rheumatoid arthritis patients. Rheumatology (Oxford). 2005;44(1):105-110. DOI: https://doi.org/10.1093/rheumatology/keh412
20 Neame R, Hammond A, Deighton C. Need for information and for involvement in decision making among patients with rheumatoid arthritis: a questionnaire survey. Arthritis Rheum. 2005;53(2):249-255. DOI: https://doi.org/10.1002/art.21071
21 Neame R, Hammond A. Beliefs about medications: a questionnaire survey of people with rheumatoid arthritis. Rheumatology. Oxford. 2005;44(6):762-767. DOI: https://doi.org/10.1093/rheumatology/keh587
22 Pascual-Ramos V, Contreras-Yáñez I, Villa AR, Cabiedes J, Rull-Gabayet M. Medication persistence over 2 years of follow-up in a cohort of early rheumatoid arthritis patients: associated factors and relationship with disease activity and with disability. Arthritis Res Ther. 2009;11(1):R26. DOI: https://doi.org/10.1186/ar2620
23 Lindén C, Björklund A. Living with rheumatoid arthritis and experiencing everyday life with TNF-α blockers. Scand J Occup Ther. 2010;17(4):326-334. DOI: https://doi.org/10.3109/11038120903480055
24 Contreras-Yáñez I, León SP, Cabiedes J, Rull-Gabayet M, Pascual-Ramos V. Inadequate therapy behavior is associated to disease flares in patients with rheumatoid arthritis who have achieved remission with disease-modifying antirheumatic drugs. Am J Med Sci. 2010;340(4):282-90. DOI: https://doi.org/10.1097/MAJ.0b013e3181e8bcb0
25 Kett C, Flint J, Openshaw M, Raza K, Kumar K. Self-management strategies used during flares of rheumatoid arthritis in an ethnically diverse population. Musculoskeletal Care. 2010;8(4):204-214. DOI: https://doi.org/10.1002/msc.185
26 Lempp H, Hofmann D, Hatch SL, Scott DL. Patients' views about treatment with combination therapy for rheumatoid arthritis: a comparative qualitative study. BMC Musculoskelet Disord. 2012;13:200. DOI: https://doi.org/10.1186/1471-2474-13-200
27 Townsend A, Backman CL, Adam P, Li LC. A qualitative interview study: patient accounts of medication use in early rheumatoid arthritis from symptom onset to early postdiagnosis. BMJ Open. 2013;3(2):e002164. DOI: https://doi.org/10.1136/bmjopen-2012-002164
28 Arvidsson S, Bergman S, Arvidsson B, Fridlund B, Tingström P. Effects of a self-care promoting problem-based learning programme in people with rheumatic diseases: a randomized controlled study. J Adv Nurs. 2013;69(7):1500-1514. DOI: https://doi.org/10.1111/jan.12008
29 Orefice D, Beauvais C, Gossec L, Flipon E, Fautrel B, Marguerie L, et al. Cross-sectional study of self-care safety skills in 677 patients on biodrugs for inflammatory joint disease. Joint Bone Spine. 2014;81(6):502-507. DOI: https://doi.org/10.1016/j.jbspin.2014.04.010
30 Aikevičienė R. Quality of life, self-care and knowledge of chronic arthritis patients treated with biological therapy. Lithuania: Lithuanian University of Health Sciences; 2014 [citado 21 maio 2023]. Disponível em: https://gs.elaba.lt/object/elaba:2214243/2214243.pdf
31 Kordasiabi MC, Akhlaghi M, Baghianimoghadam MH, Morowatisharifabad MA, Askarishahi M, Enjezab B, et al. Self Management Behaviors in Rheumatoid Arthritis Patients and Associated Factors in Tehran 2013. Glob J Health Sci. 2015;8(3):156-167. DOI: https://doi.org/10.5539/gjhs.v8n3p156
32 Meyfroidt S, van der Elst K, de Cock D, Joly J, Westhovens R, Hulscher M, et al. Patient experiences with intensive combination-treatment strategies with glucocorticoids for early rheumatoid arthritis. Patient Educ Couns. 2015;98(3):384-390. DOI: https://doi.org/10.1016/j.pec.2014.11.011
33 Zuidema RM, Repping-Wuts H, Evers AWM, Van Gaal BGI, Van Achterberg T. What do we know about rheumatoid arthritis patients’ support needs for self-management? A scoping review. Int J Nurs Stud. 2015;52(10):1617-1624. DOI: https://doi.org/10.1016/j.ijnurstu.2015.05.008
34 Betegnie AL, Gauchet A, Lehmann A, Grange L, Roustit M, Baudrant M, et al.. Why Do Patients with Chronic Inflammatory Rheumatic Diseases Discontinue Their Biologics? An Assessment of Patients' Adherence Using a Self-report Questionnaire. J Rheumatol. 2016;43(4):724-730. DOI: https://doi.org/10.3899/jrheum.150414
35 Bala SV, Samuelson K, Hagell P, Fridlund B, Forslind K, Svensson B, et al. Living with persistent rheumatoid arthritis: a BARFOT study. J Clin Nurs. 2017;26(17-18):2646-2656. DOI: https://doi.org/10.1111/jocn.13691
36 Elst K, Meyfroidt S, Cock D, Groef A, Binnard E, Moons P, et al. Unraveling Patient-Preferred Health and Treatment Outcomes in Early Rheumatoid Arthritis: A Longitudinal Qualitative Study. Arthritis Care Res (Hoboken). 2016;68(9):1278-1287. DOI: https://doi.org/10.1002/acr.22824
37 Poh LW, He HG, Chan WCS, Lee CSC, Lahiri M, Mak A, et al. Experiences of Patients With Rheumatoid Arthritis: A Qualitative Study. Clin Nurs Res. 2017;26(3):373-393. DOI: https://doi.org/10.1177/1054773816629897
38 McBain H, Newman S, Shipley M, Olaleye A, Moore S. Experiences of a patient-initiated self-monitoring service in inflammatory arthritis: A qualitative exploration. Musculoskeletal Care. 2018;16(2):278-286. DOI: https://doi.org/10.1002/msc.1232
39 Pedraz-Marcos A, Palmar-Santos AM, Hale CA, Zarco-Colón J, Ramasco-Gutiérrez M, García-Perea E, et al. Living With Rheumatoid Arthritis in Spain: A Qualitative Study of Patient Experience and the Role of Health Professionals. Clin Nurs Res. 2020;29(8):551-560. DOI: https://doi.org/10.1177/1054773818791096
40 Landgren E, Bremander A, Lindqvist E, Nylander M, van der Elst K, Larsson I. "Mastering a New Life Situation" - Patients' Preferences of Treatment Outcomes in Early Rheumatoid Arthritis - A Longitudinal Qualitative Study. Patient Prefer Adherence. 2020;14:1421-1433. DOI: https://doi.org/10.2147/PPA.S253507
41 Cea-Calvo L, Marín-Jiménez I, Toro J, Fuster-RuizdeApodaca MJ, Fernández G, Sánchez-Vega N, et al. Association between non-adherence behaviors, patients' experience with healthcare and beliefs in medications: a survey of patients with different chronic conditions. Curr Med Res Opin. 2020;36(2):293-300. DOI: https://doi.org/10.1080/03007995.2019.1676539
42 Ribeiro AA, Cunha M, Assis C, Nunes D, Fernandes L, Mariana M, et al. Fatores que influenciam o autocuidado nas pessoas com artrite reumatoide: revisão integrativa da literatura. Millenium. 2020;2(5):293-303. DOI: https://doi.org/10.29352/mill0205e.31.00340
43 Contreras-Yáñez I, Lavielle P, Clark P, Pascual-Ramos V. Markers of disease severity and positive family history are associated to significant risk perception in rheumatoid arthritis, while compliance with therapy is not: a cross-sectional study in 415 Mexican outpatients. Arthritis Res Ther. 2021;23(1):61. DOI: https://doi.org/10.1186/s13075-021-02440-y
44 Voshaar MJH, van den Bemt BJF, van de Laar MAFJ, van Dulmen AM, Vriezekolk JE. Healthcare professionals' perceptions on barriers and facilitators to DMARD use in rheumatoid arthritis. BMC Health Serv Res. 2022;22(1):62. DOI: https://doi.org/10.1186/s12913-021-07459-0
45 Michou L, Julien AS, Witteman HO, Légaré J, Ratelle L, Godbout A, et al. Measuring the impact of an educational intervention in rheumatoid arthritis: An open-label, randomized trial. Arch Rheumatol. 2021;37(2):169-179. DOI: https://doi.org/10.46497/ArchRheumatol.2022.8965
46 Gaud-Listrat V, Lopez-Medina C, Hudry C, Nguyen M, Lebrun-Foisnet A, Sacchi A, et al. Adherence to and patient's knowledge of self-management of subcutaneous biologic therapy in chronic inflammatory rheumatic diseases: results of a multicentre cross-sectional study. Clin Exp Rheumatol. 2022;40(5):928-935. DOI: https://doi.org/10.55563/clinexprheumatol/slk3yz
47 Wada M, Wallace JR. Designing technologies for self-care: Describing the lived experiences of individuals with rheumatoid arthritis. Human Factors in Healthcare. 2022;2:100025. DOI: https://doi.org/10.1016/j.hfh.2022.100025
48 Wang W, Zhou H, Liu L. Side effects of methotrexate therapy for rheumatoid arthritis: A systematic review. Eur J Med Chem. 2018;158:502-516. DOI: https://doi.org/10.1016/j.ejmech.2018.09.027
49 Miyake H, Sada RM, Akebo H, Tsugihashi Y, Hatta K. Prevalence and factors associated with polypharmacy among patients with rheumatoid arthritis: a single-centre, cross-sectional study. Clin Rheumatol. 2023;42(9):2287-2295. DOI: https://doi.org/10.1007/s10067-023-06646-0
50 Kishimoto M, Yamairi F, Sato N, Kobayashi J, Yamauchi S, Iwasaki T. Patient Preference for Treatment Mode of Biologics in Rheumatoid Arthritis: A 2020 Web-based Survey in Japan. Rheumatol Ther. 2021;8(3):1095-1111. DOI: https://doi.org/10.1007/s40744-021-00325-9
51 Kuettel D, Primdahl J, Weber U, Terslev L, Østergaard M, Petersen R, et al. Pain and Self-reported Swollen Joints Are Main Drivers of Patient-reported Flares in Rheumatoid Arthritis: Results from a 12-month Observational Study. J Rheumatol. 2020;47(9):1305-1313. DOI: https://doi.org/10.3899/jrheum.190760
52 Jonge MJS, Weijers JM, Teerenstra S, Elwyn G, van de Laar MA, van Riel PL, et al. Patient involvement in rheumatoid arthritis care to improve disease activity-based management in daily practice: A randomized controlled trial. Patient Educ Couns. 2022;105(5):1244-1253. DOI: https://doi.org/10.1016/j.pec.2021.08.013
53 Palominos PE, Gasparin AA, Andrade NPB, Xavier RM, Chakr RMS, Igansi F, et al. Fears and beliefs of people living with rheumatoid arthritis: a systematic literature review. Adv Rheumatol. 2018;58(1):1. DOI: https://doi.org/10.1186/s42358-018-0001-4
54 Raghunath S, Hijjawi R, Hoon E, Shanahan EM, Goldblatt F. Avaliação qualitativa da adesão medicamentosa em pacientes com doenças reumáticas em terapia biológica. Clin Rheumatol. 2019;38(10):2699-2707. DOI: https://doi.org/10.1007/s10067-019-04609-y
55 Andreae C, Tingström P, Nilsson S, Jaarsma T, Karlsson N, Köhler AK. Does problem-based learning improve patient empowerment and cardiac risk factors in patients with coronary heart disease in a Swedish primary care setting? A long-term prospective, randomised, parallel single randomised trial (COR-PRIM). BMJ Open. 2023;13(2):e065230. DOI: https://doi.org/10.1136/bmjopen-2022-065230
56 Marques A, Santos E, Nikiphorou E, Bosworth A, Carmonal L. Effectiveness of self-management interventions in inflammatory arthritis: a systematic review informing the 2021 EULAR recommendations for the implementation of self-management strategies in patients with inflammatory arthritis. RMD Open. 2021;7(2):e001647. DOI: https://doi.org/10.1136/rmdopen-2021-001647
57 Leonardo N, Lester S, Graham M, Barrett C, Whittle S, Rowett D, et al. Selection and perception of methotrexate treatment information in people with rheumatoid arthritis. Int J Rheum Dis. 2020;23(6):805-812. DOI: https://doi.org/10.1111/1756-185X.13833
58 Isik E, Fredland NM. Orem’s Self-Care Deficit Nursing Theory to Improve Children’s Self-Care: An Integrative Review. J Sch Nurs. 2023;39(1):6-17. DOI: https://doi.org/10.1177/10598405211050062
59 Saeedifar ES, Memarian R, Fatahi S, Ghelichkhani F. Use of the Orem self-care model on pain relief in women with rheumatoid arthritis: a randomized trial. Electron Physician. 2018;10(6):6884-6891. DOI: https://doi.org/10.19082/6884
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Revista Contexto & Saúde
This work is licensed under a Creative Commons Attribution 4.0 International License.
By publishing in Revista Contexto & Saúde, authors agree to the following terms:
The works are licensed under the Creative Commons Atribuição 4.0 Internacional (CC BY 4.0) license, which allows:
Share — to copy and redistribute the material in any medium or format;
Adapt — to remix, transform, and build upon the material for any purpose, including commercial.
These permissions are irrevocable, provided that the following terms are respected:
Attribution — authors must be properly credited, with a link to the license and indication of any changes made.
No additional restrictions — no legal or technological measures may be applied that restrict the use permitted by the license.
Notes:
The license does not apply to elements in the public domain or covered by legal exceptions.
The license does not grant all rights necessary for specific uses (e.g., image rights, privacy, or moral rights).
The journal is not responsible for opinions expressed in the articles, which are the sole responsibility of the authors. The Editor, with the support of the Editorial Board, reserves the right to suggest or request modifications when necessary.
Only original scientific articles presenting research results of interest that have not been published or simultaneously submitted to another journal with the same objective will be accepted.
Mentions of trademarks or specific products are intended solely for identification purposes, without any promotional association by the authors or the journal.
License Agreement (for articles published from September 2025): Authors retain copyright over their article and grant Revista Contexto & Saúde the right of first publication.
