Evaluation of Adherence to Drug Treatment in Patients with Rheumatoid Arthritis

Abstract

Objectives: The aim of this study was to measure the frequency of medication adherence in rheumatoid arthritis (RA) patients and to assess factors affecting it, deal with some factors to improve adherence and reevaluate after six months. Methods: A prospective cohort interventional study of 100 patients with RA under treatment fulfilled the American College of Rheumatology / European League against Rheumatism (ACR/EULAR) criteria. All patients subjected to full history taking including socio-demographic data, medication and clinical examination, Assessment of disease activity by DAS28, functional ability by Health Assessment Questionnaire (HAQ) score, pain by Visual Analogue Scale (VAS) scale, adherence to treatment by Compliance Questionnaire of Rheumatology (CQR) and Power Doppler U/S for both metacarophalangeal and wrist joints were done at baseline and after 6 months at the end of the study. Analysis of factors of non-adherence was done at baseline before intervention. Results: The baseline adherence rate (CQR≥80) was 37%. The cost of medication (62%), non-availability of medication in pharmacy (59%), lack of belief in the benefit of treatment (38%) forgetting the medication (37%) ,poor provider-patient relationship (25%), inadequate follow up (23%) and polypharmacy (20%) were the most common causes of non adherence in non adherent patients (p˂ 0.05). Adherent patients to drug treatment were younger, living inside Cairo, with higher level of education and nonsmoker. Non-adherent patients had longer morning stiffness duration (p=0.013), more tender joints, higher DAS28 and HAQ scores, higher ESR and CRP titer (p<0.001) and higher frequency of active synovitis in Doppler ultrasound. They also had significantly more frequency of having medications on their expense (p<0.001). After 6 months of follow up and trying to correct the causes of non-adherence, the adherence rate increased to 69% and this associated with improvement in disease activity, functional state and ultrasongraphic findings. Conclusion: Adherence rate to drug treatment in RA patients at baseline was low (37%). It was associated with higher disease activity, functional disability. Patient education, financial support, good physician-patient relationship and simplification of the prescription were found to improve the patient adherence to treatment and to control disease activity after follow up. [Egypt J Rheumatology & Clinical Immunology, 2016; 4(1): 81-92]

Adherence to Biologic Drugs Among Patients With Immune Mediated Inflammatory Diseases in Duhok Governorate

“…, who stated that younger patients had less adherence with medication than older patients, while two studies conducted in Egypt 19,20 showed that younger age was more adherent, this dissimilarity due to considering age as inconsistent factors that influenced by other confounding factors such as presence of comorbidities and complexity of the medical regimens which often associated with older age 6 and may be due to active lifestyle of younger patients making them pay less attention to their clinical illness 21 . No association between gender and adherence to biological drugs found in this study which is similar to the Iranian study about adherence to chronic illness that found gender as an unessential factor affecting medication adherence 22 , in contrast to the Indian study that found female gender as main determinate of none-adherence 23 .…”

Hearing profile in patients with Rheumatoid Arthritis and Systemic Lupus Erythematosus

“…Alhefny et al (12) studied 28 RA patients and there was no significant difference in mean compliance between RA patients and controls. There was an increase in the Wave I latency of ABRs in Group 1 (1.639/ 0.08 ms) compared to Group 2 (1.609/ 0.08 ms).…”

Serial multiple mediation of treatment adherence and disease activity in the relationship between continuity of care and health outcomes among rheumatoid arthritis patients

“…[22][23][24][25][26][27][28][29][30][31] Likewise, it has been determined that the number of studies examining the treatment adherence levels of rheumatoid arthritis patients is high. [32][33][34][35][36][37][38][39][40][41] However, it has been determined that the number of studies on the continuity of care in rheumatoid arthritis patients is limited to only one study, 42 and more importantly, there is no study that evaluates the relationship between continuity of care and health outcomes with a comprehensive disease management approach.…”

“…When the literature on rheumatoid arthritis is examined, it is possible to come across studies that examine the effects of rheumatoid arthritis on health outcomes such as quality of life and physical activity disorder in terms of one dimension in both international and national literatüre 22–31 . Likewise, it has been determined that the number of studies examining the treatment adherence levels of rheumatoid arthritis patients is high 32–41 . However, it has been determined that the number of studies on the continuity of care in rheumatoid arthritis patients is limited to only one study, 42 and more importantly, there is no study that evaluates the relationship between continuity of care and health outcomes with a comprehensive disease management approach.…”