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LETTER TO EDITOR
Ahead of print publication  

Response to: Impact of household dynamics and familial support in influencing beliefs toward medications in patients with rheumatoid arthritis


 Department of Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, India

Date of Submission06-Oct-2020
Date of Acceptance15-Oct-2020

Correspondence Address:
Prasanta Padhan,
Department of Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar - 751 024, Odisha
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/injr.injr_280_20



How to cite this URL:
Ahmed S, Mahapatra A, Behera BK, Padhan P. Response to: Impact of household dynamics and familial support in influencing beliefs toward medications in patients with rheumatoid arthritis. Indian J Rheumatol [Epub ahead of print] [cited 2021 Dec 9]. Available from: https://www.indianjrheumatol.com/preprintarticle.asp?id=326159



Dear Editor,

We thank Ahmad Saud for his interest[1] in our paper on beliefs about medications among patients with very early rheumatoid arthritis (RA) that had shown that most of the patients (96.8%) were indifferent despite having high concerns about the medicines in general.[2] He presents some interesting insights regarding the social structure in India and hypotheses how this might have influenced the findings of the study. As the population dynamics of India change, the effects of the transition from joint to nuclear families may become more prominent.[3] It will be interesting to see if beliefs toward medications change with this shift.

We agree with his observations but would like to present two clarifications. First, there is an expression that a crucial social dynamic regarding family structure had been left out in the study. However, the present study was designed to explore patients' belief and not the reasons for those beliefs. Second, the possible role of an extended family providing social support to the patients has been well-expressed. Although we agree this may be one of the factors influencing patients' beliefs, we are of the opinion that this is not the only possible explanation.

A dominant character in the behavior of Indians is the effect of religion and various religious beliefs. The presence of religious beliefs alters behavioral patterns across socio-cultural groups including age, education, and country of origin.[4] This may provide an alternate explanation wherein a majority of patients attribute disease as originating from a supernatural power, and thus, are indifferent to how they are being cured. This may be more relevant in the context of chronic disease, as well as for arthritis. As indirect evidence supporting this, 41.2% of the patients had visited a complementary and alternative medicine practitioner before visiting a practicing rheumatologist.

Another explanation may be that Indian patients with RA may tend to repress their pain and physical disability, as these are the considered signs of weakness.[5] This repression may be generalized to all aspects of the disease including medications. Thus, to study the causes behind the attitude of Indian patients with RA may require extensive work including preliminary qualitative studies.[6] It should also be kept in mind that, as mentioned in our manuscript, these were only behaviors in patients early on in the course of their disease. As they understand the disease and the drugs better, their beliefs might change over time.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Saud, Ahmad. Impact of Household Dynamics and Familial Support in Influencing Beliefs Towards Medications in Patients with Rheumatoid Arthritis. Indian J Rheumatol 2020: DOI 10.4103/injr.injr_244_20.  Back to cited text no. 1
    
2.
Ahmed S, Mahapatra A, Behera BK, Padhan P. Beliefs and outlook toward medications in Indian patients with very early rheumatoid arthritis: Cross sectional survey. Indian J Rheumatol 2020;15:298-303.  Back to cited text no. 2
  [Full text]  
3.
Allendorf K. Going nuclear? Family structure and young women's health in India, 1992-2006. Demography 2013;50:853-80.  Back to cited text no. 3
    
4.
Daws RE, Hampshire A. The Negative Relationship between Reasoning and Religiosity Is Underpinned by a Bias for Intuitive Responses Specifically When Intuition and Logic Are in Conflict. Front Psychol 2017;8:2191.  Back to cited text no. 4
    
5.
Aggarwal A, Chandran S, Misra R. Physical, psychosocial and economic impact of rheumatoid arthritis: A pilot study of patients seen at a tertiary care referral centre. Natl Med J India 2006;19:187-91.  Back to cited text no. 5
    
6.
Paskins Z, Hassell AB. Qualitative research in RA. Rheumatology 2012;51:3-4.  Back to cited text no. 6
    




 

 
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