Background Rheumatoid arthritis (RA) is a chronic inflammatory disorder that typically affects small and medium sized joints in a symmetric manner. In RA joint damage with loss of function can occur. To reduce the risk of joint damage and functional impairment a high degree of adherence by patients to their prescribed regimen is necessary for optimal outcomes. However, poor adherence to drug is suspected in many patients.
Objectives Identify potential determinants of adherence to disease modifying anti-rheumatic drugs (DMARDs) including the level of education in RA patients.
Methods This survey was conducted in the outpatient Rheumatology department. 232 consecutive adult RA patients were included in a survey during their routine rheumatology appointments. RA patients fulfilled EULAR/ACR 2010 or ARA criteria for RA. Survey was designed to record adherence to different RA treatments using two questionnaires, one for a rheumatologist and one for a patient. The data from both questionnaires was entered into a database and statistically evaluated. All the analyses were performed in the R statistical software, version 3.2.2. (R Foundation for Statistical Computing, Vienna, 2015).
Results The surveyed patient population was mostly female (79.7%) with a mean age of 59.3 years (SD=10, range 26–83). 64.3% of patients were rheumatoid factor (RF) positive. According to DAS-28, 7.5% of patients had high disease activity, 34.6% moderate, 21.1% low, and 36.8% patients were in remission. 62.8% of patients had secondary, 20.8% primary and 16.5% university degree of education. At the time of survey, 10% of patients were unemployed, 24% were working and 65.9% were retired. There were 63%, 73% and 88% patients with primary, secondary and university education, respectively, adherent to cs-DMARDS. Considering education there's borderline statistically significant difference in adherence in DMARDs' treatment (p=0.0517). The adherence to folic acid treatment was somewhat lower: 38%, 37% and 48% in patients with primary, secondary and university education, respectively. No impact of education on adherence was found in corticosteroid treatment group. No significances in adherence considering education were found in corticosteroid and folic acid treatment (p=0.937 in p=0.629). There seems to be no clear trend in adherence with respect to patient age, gender and marital status, while the unemployed patients seem to be less adherent in all therapies. We observed the lowest adherence in patients with high disease activity.
Conclusions Education degree seems to be important factor considering adherence in RA patients treated with cs-DMARDS. The best adherence was observed in patients with highest education degree.
Kumar K, Raza K, Nightingale et al.Determinants of adherence to disease modifying anti-rheumatic drugs in White British and South Asian patients with rheumatoid arthritis: a cross sectional survey. BMC Musculoskelet Disord. 2015 Dec 29;16(1):396.
Pasma A, Schenk CV, Timman R, et al. Non-adherence to disease-modifying antirheumatic drugs is associated with higher disease activity in early arthritis patients in the first year of the disease.Arthritis Res Ther. 2015 Oct 8;17:281.
De Cuyper E, De Gucht V, Maes S, et al. Determinants of methotrexate adherence in rheumatoid arthritis patients. Clin Rheumatol. 2016 Jan 19. [Epub ahead of print]
Disclosure of Interest None declared