Table 4 Overview of the themes arising from patient interviews surrounding potential withdrawal of disease-modifying anti-rheumatic drug (DMARD) therapy

Uncertainty after DMARD withdrawal

Uncertainty and unpredictability of developing flare of RA after DMARD withdrawal

Getting rid of unnecessary medication

Benefits of stopping “unnecessary medication” in terms of avoidance of toxicity and the need for blood monitoring

Feeling of loss of control over disease

DMARDs as a “weapon” that fights disease, without which patients feel a loss of control over their RA

Previous disease experiences

Personal or family/friend experience of treatment-resistant or deforming RA is a strong disincentive to DMARD withdrawal

Social circumstances

Patient less likely to consider DMARD withdrawal if their social circumstances make them vulnerable to disease flare and periods of reduced physical function – e.g. caring for dependent family member, manual worker.