Compliance with treatment of rheumatoid arthritis

Abstract

Rheumatoid arthritis (RA) is a chronic, progressive, debilitating disease that demands continuous therapy with multiple medications. Noncompliance with disease-modifying drugs may cause disease flares, preventable functional impairment, unnecessary treatment changes, and loss of health care resources. The aim of the current study was to explore self-reported compliance with treatment and the factors contributing to this compliance using a representative sample of an RA patient population in Estonia. Two thousand patients diagnosed with RA were randomly selected from the Estonian Health Insurance Fund database. The eligible response rate of the study was 60%. Using prestructured questionnaires, the following information about the disease and treatment was evaluated: self-reported compliance with treatment, reasons for noncompliance, disease history, sociodemographic variables, health care utilization, and satisfaction with health care providers. The self-reported compliance rate was 80.3%, reflecting the percentage of patients who reported that they always took their medications exactly as described. The most often reported reasons for noncompliance were side effects and fear of side effects. Compliance was found to be the lowest in a group of younger and active patients with higher income. Higher frequency of visits to the rheumatologist, satisfaction with health care providers, and sufficient information about RA treatment correlated with better compliance.

Psychological Factors Associated with Response to Treatment in Rheumatoid Arthritis

“…It has been repeatedly demonstrated that then immune system plays a pivotal role in the biology of a large array of psychiatric disorders, including not only major depression but also schizophrenia and autism [47][48][49]. Such observations support the possibility that the immune system plays a key pathophysiological role in the concomitant development and progression of psychopathology and autoimmune disorders.…”

“…Communication between physician and patient is crucial to adherence. Muller et al (2012) found that patients who were satisfied with their physicians had significantly higher levels of adherence than those who were not [48]. Other studies have found that improved patient knowledge about the disease and the medication and a higher frequency of visits to the physician are correlated with better adherence [169,170].…”

“…Depression has been shown to occur with remarkable frequency after immune challenges such as vaccination [55], administration of endotoxin [56], and anti-IFN-therapy [57]. Conversely, there is evidence that anti-inflammatory therapies can relieve depressive symptoms in the absence of somatic disease [48,58,59]. Antide-pressive drugs have immunomodulatory effects.…”

“…Furthermore, in patients with RA and concomitant/secondary fibromyalgia, DAS28 has been reported to overestimate disease activity [124,125], possibly because of application of the visual analog scale for general health and tender joint count, which focus on the more subjective components of DAS28 [48]. These authors suggested that in order to reliably estimate an individual's disease activity, the individual components of DAS28 should also be examined, and that if the 2 measures listed above are high relative to ESR and swollen joint count, tender joints should be assessed.…”

“…Such beliefs and divergence need to be addressed, as they may unduly interfere with the physician's selection of therapy and with the patient's commitment to the strategy. Communicating, discussing the goals and alternatives of the treatment with the patients, and making joint decisions seem to be essential for achieving optimal adherence [48,140].…”