Assessment and Prediction of Adherence to Methotrexate Using Three Self-Report Questionnaires in Patients with Rheumatoid Arthritis

Abstract

Objective: This study aimed to estimate adherence to methotrexate in patients with rheumatoid arthritis and identify specific nonadherence risk factors. Methods: A cross-sectional study included 111 patients (age mean 56.2±10.6 years, 78.4% female, and disease duration mean 6 (3-13) years). Three adherence self-assessment questionnaires were used: the Compli-ance-Questionnaire-Rheumatology (CQR19), the Medication Adherence Reports Scale (MARS-5), and the Visual Analogue Scale (VAS). We also collected demographic data, disease and treatment characteristics, and anxiety/depression estimation results (Hospital Anxiety and Depression Scale- HADS). Results: Adherence was identified in 48.6% of patients (COR19), 70.3% (MARS-5), and 82.9% of patients in the VAS questionnaire. All three questionnaires displayed a significant positive mutual correlation: CQR19 with MARS-5 and VAS (r =0.364, r=0.329 respectively, p<0.001 for both), between VAS and MARS-5 score (r=0.496, p<0.001). A significant positive prediction was shown for urban residence (0.347 (0.134-0.901), p=0.030), using the MARS-5 scale, female sex (0.264 (0.095-0.730), p=0.010) according to CQR19 and for a dose of methotrexate (0.881 (0.783-0.992), p=0.036) in VAS scale, while negative prediction were shown for comorbidity number (3.062 (1.057-8.874), p=0.039), and depression (1.142 (1.010-1.293), p=0.035) using MARS-5 scale and for older age (1.041 (1.003-1.081), p=0.034) according to CQR19. The use of steroids was a significant positive predictor in all three questionnaires and remained an independent predictor for metho-trexate adherence in multivariant logistic regression. Conclusion: We showed nonadherence to methotrexate in a significant number of patients using all three questionnaires. Concomitant steroid therapy emerged as an independent positive predictor for adherence.