OBJECTIVE: To explore what considerations patients have when deciding about 
disease-modifying antirheumatic drugs (DMARDs) and what information patients 
need to participate in the decision-making process.
METHODS: In-depth face-to-face interviews were conducted with 32 patients with 
inflammatory arthritis who recently consulted their rheumatologist and discussed 
initiating DMARDs.
RESULTS: Beliefs in the necessity of DMARDs, either for relief of symptoms or 
prevention of future joint damage, were reasons to initiate DMARDs. Furthermore, 
trust in the rheumatologist and the health care system was important in this 
respect. Patients expressed many concerns about initiating DMARDS. These related 
to the perceived aggressive and harmful nature of DMARDs, potential (or unknown) 
side effects, influence on fertility and pregnancy, combination with other 
medicines, time to benefit, and manner of administration. Participants also 
worried about the future regarding long-term medication use and drug dependency, 
and if a medicine proved to be ineffective, about the risks of future treatments 
and running out of options. To decrease uncertainty, participants wanted to be 
informed about multiple treatment options, both current and future. They not 
only wanted clinical information but also information on how the medications 
could affect their daily lives.
CONCLUSION: Health education should inform patients about multiple treatment 
options, for the present as well as for the future. It should enable patients to 
compare treatments with regard to both clinical aspects as well as possible 
consequences for their daily lives.