Patients’ concerns regarding biological agents in
Mustafa Ferhat OKSUZ,
Ahmet Mesut ONAT
and Ediz DALKILIC
Department of Rheumatology, School of Medicine, Uludag University, Bursa,
Department of Nursing, Health Science Faculty,
Uludag University, Bursa,
Department of Rheumatology, School of Medicine, Gaziantep University, Gaziantep,
Rheumatology, Meram School of Medicine, Necmettin Erbakan University, Konya,
Department of Rheumatology, School of
Medicine, Cumhuriyet University, Sivas, and
Department of Rheumatology, School of Medicine,
Izmir Katip Celebi University,
Objective: The potential side effects of biological agents may increase the anxiety levels of patients and inﬂuence
not only their desire to use these therapies but also their concordance to treatment. This study aimed to deter-
mine the level and prevalence of drug-related concern in patients treated with biological agents and to acquire
additional information regarding the related causes.
Materials and Methods: A total of 1134 patients who were using biological agents for at least 3 months with a
diagnosis of rheumatic diseases were enrolled. General anxiety levels were evaluated using the State-Trait Anxiety
Results: The most common cause for drug-related concerns was the potential side effects of the drugs (59.5%).
Among the potential side effects, cancer risk was the most common cause for concern (40.1%), followed by the
risk of tuberculosis activation (30.7%). Anxiety levels were higher in patients who experienced side effects than
in other patients, and this difference was statistically signiﬁcant (P < 0.05). STAI trait and state scores were mod-
erately correlated with anxiety levels related to the drug (P < 0.001).
Conclusion: Anxiety related to biological agents may signiﬁcantly affect the patients’ anxiety levels. Awareness
regarding the patients’ concerns and expectations related to the drug is important to ensure drug adherence and
concordance to treatment.
Key words: biological agents, patient, patients’ concern, rheumatology.
Anxiety, described as a neurosis, is characterized by anx-
ious over-concern extending to panic and is frequently
associated with somatic symptoms according to the
Diagnostic and Statistical Manual of Mental Disorders.
Mood and anxiety disorders are common comorbid
conditions in patients with rheumatic diseases.
these patients, anxiety frequency was reported in vary-
ing proportions to be 30–70%.
The presence of anxiety is correlated with quality of
life and anxiety is an independent predictor of disease
activity in patients with early arthritis.
comorbidity appears to be the most important indepen-
dent predictor of work disability in patients with
inﬂammatory rheumatic diseases.
Thus, concerns and
Correspendence: Dr Seda Pehlivan, Health Science Faculty, Ulu-
dag University, Bursa TR-16059, Turkey.
© 2018 Asia Paciﬁc League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd
International Journal of Rheumatic Diseases 2018; 21: 1219–1226