Background Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are chronic systemic illnesses that demand lifelong treatment. Adhesion to therapy is fundamental to achieve adequate disease control.
Objectives We aimed to assess adherence to chronic therapy in RA and PsA patients and to identify reasons of non-adherence.
Methods An anonymous written self-reported questionnaire was applied to consecutive RA and PsA patients followed-up in our Day Care Rheumatology Unit. Demographic and clinical characteristics were evaluated as well as chronic medication prescribed. Medication adherence was assessed using a qualitative 4-point scale. Patients were deemed adherent when stated that drug was always taken as prescribed. Reasons for non-adherence were collected. Presence and intensity of side effects was also investigated. Patients were asked to indicate one drug that they would like to stop and to specify the reasons for their choice. Variables independently associated with non-adherence where assessed by logistic regression analyses.
Results One hundred and five participants were included: 83 females, 85 RA patients, with a mean age of 55±13 years and mean disease duration of 13±8 years. Drugs with lowest self-reported adherence were calcium supplements (58.3%, n=60) followed by hydroxychloroquine (62.5%, n=16) and the drugs with highest level of adherence were subcutaneous biologics (90.9% of patients, n=44) and leflunomide (85.7%, n=7). Forgetfulness was most often the perceived reason for non-adherence (67.8% of patients, n=59), followed by fear/presence of side effects (11.9% each). The drugs most frequently appointed for discontinuation were methotrexate (50% of patients, n=64) and glucocorticoids (23.4%), mainly due to fear of (69.4%, n=62) or presence of adverse events (27.4%). Methotrexate side effects most often indicated were nausea (25.3% of patients, n=87) and hair loss (18.4%). Younger age was associated with non-adherence to methotrexate and calcium supplement use (table 1).
Conclusions We identified forgetfulness and fear/presence of side effects as the main barriers to adherence. Consequently, we are committed to improve doctor-nurse/patient communication, assuring a clear and individual explanation of the importance of maintaining adherence and possible side effects of each therapy at the beginning of treatment and at each consultation. Proactive management of side effects, even if mild, is encouraged. Additionally, health care professionals should encourage and implement group education sessions where rheumatic diseases and treatments are discussed with patients and where there will be the opportunity to clarify doubts and improve coping strategies.
Disclosure of Interest None declared