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

Abstract

Objective. To describe patterns of adherence to nonsteroidal antiinflammatory drugs (NSAIDs) in newly diagnosed patients with juvenile rheumatoid arthritis (JRA), and to examine demographic and disease-related variables as potential predictors of adherence. Methods. Adherence to NSAIDs was monitored in 48 children with JRA (mean age 8.6 years) over 28 consecutive days using an electronic monitoring device. Measures of disease activity (active joint counts, morning stiffness) and demographics (age, sex, ethnicity, socioeconomic status) were also obtained. Results. Using an 80% adherence cut point, 25 (52%) patients were classified as adherent and 23 (48%) as nonadherent. There was considerable variability across patients, with full adherence (taking all doses on time) ranging from 0 to 100% of the monitored days. Logistic regression showed that active joint count and socioeconomic status were the only significant predictors. Both were positively related to adherence. The model correctly classified 70.5% of patients as either adherent or nonadherent (Cox and Snell R 2 ‫؍‬ 0.295, P ‫؍‬ 0.0005). Conclusion. Children newly diagnosed with JRA are more likely to adhere to an NSAID regimen if they have a greater number of active joints or their families have higher socioeconomic status. The former finding suggests that children's adherence is symptom-driven, while the latter suggests that families of lower socioeconomic status deserve special attention to address adherence issues.

Factors associated with adherence to treatment in children and adolescents with chronic rheumatic diseases

“…Em nosso estudo, a taxa de adesão ao tratamento medicamentoso foi de 79,7%, e de uso de órteses foi de 52,6%, consistentes com a literatura 2,4,6,7,11,13,14 .…”

“…Com relação à terapêutica, o termo "boa adesão" é utilizado quando há o uso regular de mais de 80% dos medicamentos e de outras modalidades de tratamento prescritas [2][3][4][5][6] .…”

“…O interesse na avaliação da adesão de crianças e adolescentes com doenças crônicas tem aumentado nas últimas décadas, e os estudos que avaliam adesão em doenças reumáticas, em sua maioria, incluem apenas pacientes com artrite idiopática juvenil (AIJ) 3,4,6,7,9,[11][12][13][14] . As taxas de adesão à medicação em doenças reumáticas crônicas em crianças e adolescentes variam de 38 a 96% 2,4,6,7,11,[13][14][15] , sendo menores em adolescentes (50-55%) 2,15 .…”

“…As taxas de adesão à medicação em doenças reumáticas crônicas em crianças e adolescentes variam de 38 a 96% 2,4,6,7,11,[13][14][15] , sendo menores em adolescentes (50-55%) 2,15 . Em relação ao tratamento não medicamentoso, a adesão varia de 40 a 86% para exercícios 2,6,11,13,14 e cerca de 50% para uso de órteses 2 .…”

Medication compliance among children

“…These monitors store downloadable timeand date-stamped information for up to several months and can provide precise information on the frequency and timing of actual dosing and reveal daily patterns of compliance. [17] The latter ranges from simple calendars and reminders to sophisticated electronic "pill boxes" with the capability to record the time that the medication was removed from the box.…”