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OP0197-HPR Psychosocial Predictors of DMARD Adherence in The First Three Months of Treatment for Early Arthritis
  1. A. Pasma1,
  2. J.M. Hazes2,
  3. J.J. Busschbach3,
  4. W.H. van der Laan4,
  5. C. Appels5,
  6. Y. de Man6,
  7. D. Nieboer7,
  8. R. Timman8,
  9. A. van 't Spijker8
  1. 1Rheumatology, Erasmus MC, Nijmegen
  2. 2Rheumatology
  3. 3Psychiatry, Erasmus Medical Center, Rotterdam
  4. 4Rheumatology, Sint Maartenskliniek, Nijmegen
  5. 5Rheumatology, Amphia, Breda
  6. 6Rheumatology, St. Antonius hospital, Nieuwegein
  7. 7Public Health
  8. 8Psychiatry, Erasmus MC, Rotterdam, Netherlands


Background To induce disease remission, early arthritis patients should adhere to their disease-modifying antirheumatic drugs (DMARD) in the first months after diagnosis.1 It remains unknown why some patients do not adhere to their therapy.

Objectives In this study we aimed to identify which patients are at risk for non-adherence in the first 3 months of treatment.

Methods Adult DMARD-naïve early arthritis patients who started synthetic DMARDs were recruited for a cohort study. At baseline, patients filled out items on potential adherence predictors. These items were based on a literature review and focus group interviews.2 Items included amongst others questions on coping with pain and the disease, anxiety and depression, and beliefs and expectations about medication. Adherence was in the first 3 months of treatment continuously measured with electronically monitored pill bottles. Items were reduced and clustered using principal component analysis. Per cluster of items, latent trait models were constructed to extract the most discriminating items. Per DMARD and per day non-adherence was defined as not opening the pill bottle when it should have been. We conducted a multilevel multivariable logistic regression model to find predictors for non-adherence.

Results 301 patients agreed to participate of which 259 completed follow-up. Adherence was high and declined over time. Principal component analysis led to 7 dimensions, while the subsequent latent trait models analyses led to 15 dimensions. Of these dimensions, “information seeking” and “having positive expectations about the disease” were associated with adherence and the dimension “adjusting to the pain” was associated with non-adherence (see table 1).

Conclusions Our findings suggest that patients who experience autonomy through information seeking behavior and having positive expectations about the course of the disease are more prone to be adherent than patients who feel less autonomous and become passive because of pain: these patients are at risk for non-adherence.

  1. Smolen JS, Landewe R, Breedveld FC, Buch M, Burmester G, Dougados M et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Ann Rheum Dis 2014 Mar;73:492–509.

  2. Pasma A, Hazes JMW, Luime JJ, Busschbach JJV, van 't Spijker A. How to study determinants related to medication adherence in newly diagnosed polyarthritis patients for the development of a prediction instrument. Patient Preference and Adherence 2014;8:1437–47.

Disclosure of Interest None declared

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