Adherence to methotrecate therapy in Rheumatoid Arthritis

Abstract

Objective:To determine adherence to methotrexate (MTX) therapy in patients with Rheumatoid Arthritis (RA) and to identify factors that promote either adherence or non adherence.Methods:One hundred Rheumatoid Arthritis patients on MTX for at least two months were enrolled. Questionnaire was completed by direct interview. Details recorded were, demographics (age, sex, education, monthly income), disease duration, duration on MTX and current dose. Disease Activity Score on 28 joint counts (DAS 28) at the current visit, concomitant drugs taken and number of doses of MTX missed in the previous 8 weeks were noted. Non adherence was defined as omission of any three or more prescribed doses of MTX in previous 8 week. Patients were asked for the factors that motivated their adherence to MTX as well as factors for non adherence. Presence of side effects due to MTX was also recorded.Result:Non adherence was found among 23% of cases. Patients of low socioeconomic group (p <0.0001) and on MTX for longer duration (p <0.001) had higher non adherence. Non adherent patients had significantly higher disease activity as measured by DAS 28 (p<0.001). Good counseling and education by the doctor was a strong predictor of adherence (p <0.001). Lack of affordability (p <0.001); lack of availability at local pharmacy (p <0.001); lack of family support (p <0.001) and lack of awareness regarding need and importance of MTX (p < 0.001were found as significant factors for non adherence.Conclusion:MTX non adherence in RA is noted in about one fourth of study group. Various economical and social issues lead to non adherence but good patient education and counseling by doctor could promote adherence in this study group.

Mobile Phone Text Messages and Effect on Treatment Adherence in Patients Taking Methotrexate for Rheumatoid Arthritis: A Randomized Pilot Study

“…Its treatment is now well codified; MTX is the first‐line drug and is usually maintained when biologics become necessary . Various studies suggest that adherence may be suboptimal in 25% of patients taking MTX . In the current study, the proportion of nonadherent patients was slightly higher (close to 40%), since the use of a combination of scores is known to avoid the overestimation of adherence .…”

“…In RA, the estimated percentage of patients with good adherence to MTX ranges from 59% to 100%, depending on the evaluation method used . In a pooled analysis of 13,358 patients in published MTX adherence studies, this percentage was 75.6% . Studies based on electronic medication event monitoring systems gave similar results .…”

A Case That Reveals the Importance of Adherence to Treatment: Development of Cervical Subluxa2on in a Homeless Rheumatoid Arthri2s Pa2ent

“…Bu da uzun vadede fonksiyonel yetersizliklere yol açıp, toplumdaki morbidite ve mortalite oranlarını artırmaktadır. 7 El ve ayak eklemlerinin dışında servikal omurgadaki eklemler de RA'dan etkilenen eklem grubunu oluşturmaktadır. 10 Atlantoaksiyel eklem subluksasyonu en yaygın (%65) görülen SOT formudur.…”

“…Hastanın özellikle metotreksat tedavisine uyumu olmaması demek; hastalığın kontrol altına alınamaması, eklemlerde yaygın destrüksiyon oluşması ve yüksek hastalık aktivitesi demektir. 7 Bu da SOT oluşum riskini önemli ölçüde artıran bir faktör olmaktadır. Kaito ve ark.nın yaptığı çalışmada; güncel farmakolojik tedaviler altında servikal tutulum insidansı incelenmiştir.…”

“…Bu sürecin başarıya ulaşabilmesi, komplikasyonların önlenebilmesi açısından da birçok çalışma göstermiştir ki hastanın tedaviye uyumu en önemli bileşenlerden biridir. [7][8][9] Bu çalışmada, 16 yıl önce RA tanısı almış, fakat sosyal problemlerden dolayı tedaviye devam edememiş olguda, SOT gelişimi ile ortaya çıkan tetraparezi tablosunun gelişimine ve bu durumun önlenebilirliğine dikkat çekilmesi amaçlanmıştır.…”