Compliance With Salicylate Therapy in Adolescents With Juvenile Rheumatoid Arthritis

Abstract

\s=b\ We compared adolescents' compliance with medical regimens with that of younger children and identified characteristics of noncompliant adolescents. Compliance among 82 patients with juvenile rheumatoid arthritis (JRA) was monitored using serum salicylate levels. Fifty-five percent of adolescents and 55% of children were found to have good compliance. Among adolescent patients with JRA, however, the following factors were associated with salicylate therapy noncompliance: longer duration of disease (more than six years); earlier age at onset (under 9 years); later time of referral to a subspecialist; shorter duration of subspecialty cl i ni c care; and fewer clinic visits.Knowledge of these variables will facilitate development of intervention strategies tailored to meet the age-specific needs of this population with chronic illness. (Am J Dis Child 1981:135:434-436)The stereotype of adolescent noncompliance with prescribed medi¬ cal regimens is based on limited data. To date, only two studies have under¬ taken to compare adolescents' com¬ pliance with that of younger children.In the first, Korsch et al found 13 of 14 noncompliant patients to be adoles¬ cents,' whereas Smith et al found 59% of adolescents and only 18% of chil¬ dren with neoplasms to be noncom¬ pliant with the prescribed medical regimen.2 In both studies, the medica¬ tion was prednisone, and it is plausible to speculate that its adverse effect on the adolescents' appearance contrib¬ uted to the observed noncompliance. Two other studies of compliance among chronically ill adolescents ex¬ plored its relationship with having the same physician. Meyers et al found no relationship between consistency of physicians and compliance among ad¬ olescents with cystic fibrosis.3 Heinzelmann, however, reported a nega¬ tive association between having the same physician and compliance of col¬ lege students who required penicillin prophylaxis for rheumatic fever.4 He did find that compliance was en¬ hanced when the physician was a spe¬ cialist rather than a generalist. Other than these studies, little has been written about the determinants of medication compliance among adoles¬ cents with chronic illness.0 Compliance with medication for chronic illness has been extensively studied in adults.Factors associated with their noncom¬ pliance include the duration of the illness, complexity of the regimen, lack of symptoms, and long intervals between clinic visits.6 Increasing pa¬ tient supervision,7 simplification of the therapeutic regimen," initiation of a behavioral modification program," and vision of social support'" have been shown to improve compliance among adults with chronic illness in a variety of studies.The present study was undertaken to (1) compare compliance with sodi¬ um salicylate medication of adoles¬ cents with juvenile rheumatoid arthritis (JRA) with that of younger children, and (2) to identify character¬ istics that may distinguish adolescent compilers from noncompliers. The objective of this approach is to under¬ stand better the factors that...

Adherence to methotrexate in juvenile idiopathic arthritis

“…Rapoff et al reported that half (48%) of 48 American patients with JIA were non-adherent to NSAID treatment [5]. Similarly, Litt and Cuskey found that 45% of 82 patients with JIA were non-adherent to salicylate therapy [12]. In another report, Degotardi et al found 30% non-adherence to medications in patients with JIA [3].…”

Electronically monitored adherence to medications by newly diagnosed patients with juvenile rheumatoid arthritis

“…Two retrospective studies by Litt and colleagues found that 55% of children and adolescents with JRA were adherent to salicylate medications as determined by serum assays (3,4). In 3 separate within-subject design studies involving 5 patients with JRA (ages 3 to 14 years), baseline adherence with medications was assessed by parental observations or pill counts and ranged from 38 -59% (5-7).…”

“…Few studies have examined predictors of adherence to medication regimens for JRA. Litt and Cuskey (3) found that lower adherence to salicylate medications among 38 adolescents with JRA was associated with younger age at disease onset, longer disease duration, shorter duration of subspecialty care, greater delay between disease onset and first subspecialty clinic visit, and fewer clinic visits. Litt et al (4) found that higher selfesteem and autonomy (assuming more responsibility for health care in the context of a positive relationship with parents) were predictive of higher adherence to salicylate medications among a separate group of 38 adolescents with JRA.…”

Adherence with drug therapy in the rheumatic diseases Part one: A review of adherence rates

“…Mean levels of adherence for patients with gout were 65%, osteoarthritis 53.9% and ankylosing spondylitis 51.4%. Scrutiny of the data demonstrated that only two studies used objective measures of assessment; levels of uric acid (Hernandez et al, 1978) and salicylate (Litt and Cuskey, 1981). The former produced the lowest level of adherence, 32%, and the latter the second lowest (55%).…”