Stress at Home and Female Gender Are Significantly Associated With Non-adherence and Poor Illness Perception Among Patients With Rheumatoid Arthritis

Abstract

Aims We aimed to assess the level of non-adherence and poor illness perception among rheumatoid arthritis (RA) patients. Additionally, we examined their associations with clinical indicators and outcomes. Methods This was a cross-sectional study conducted using data collected at the time of patient enrolment in the Pakistan Registry of Rheumatic Diseases (PRIME) registry. A wide range of clinical variables was studied. To measure adherence, we used the Urdu version of the General Medication Adherence Scale (GMAS), which has recently been validated in RA patients. A Brief Illness Perception Questionnaire (BIPQ) was used to measure illness perception. Results The data of consecutive 320 RA patients were reviewed. Thirty-six percent of the cohort (n=116) was noted to have non-adherence. On multiple logistic regression analysis, a significant association of non-adherence was noted with moderate-to-severe stress (odds ratio {OR}: 1.85, confidence interval {CI}: 1.04-3.2), DAS-28 scores (OR: 1.83, CI: 1.52-2.21), Health Assessment Questionnaire (HAQ) scores (OR: 1.77, CI: 1.07-2.92), and deformed joint counts (OR: 1.30, CI: 1.15-1.46). Additionally, non-adherence due to "patient behavior" had a significant association with the male gender (OR: 0.48, CI: 0.26-0.87), unemployment (OR: 1.82, CI: 1.07-3.10), and stress at home (OR: 2.17, CI: 1.35-3.49). Twenty-six percent of the cohort (n=86) was noted to have the most negative illness perception, and on multiple logistic regression analysis, it was significantly associated with male gender (OR: 0.24, CI: 0.11-0.53), age of onset of arthritis (OR: 0.96, CI: 0.94-0.99), and worse HAQ scores (OR: 3.7, CI: 2.2-6.1). Conclusions Important adverse factors contributing to non-adherence and negative illness perception highlighted in this study were stress at home, female gender, and younger age of patients.

A Prospective Follow-Up Study on the Disease Course and Predictors of Poor Outcomes in a Random Population-Based Cohort of Newly Diagnosed Lupus Patients

“…We have not encountered a single study contradicting these findings or ruling stress out as a poor prognostic indicator. Stress at home has been identified as a major risk factor for non-compliance, and this possibly explains its indirect contribution to poor outcomes [ 19 ].…”

“…Evaluation of disease activity and severity was made as per internationally recognized and validated measures, and for this study, we extracted data from routinely collected SLEDAI-2K activity measures. All participants were directly queried via an interview at the time of patient enrolment about the presence or otherwise of mental/emotional stress at home, and asked to rate their responses on a scale of 1-3 (mild, moderate, and severe) [ 19 ]. For better understanding and ease of data analysis, a dichotomous variable was constructed with moderate-to-severe stress patients categorized into one group and non-to-mild stress patients into another group.…”

The Adherence and Outcomes Benefits of Using a Connected, Reusable Auto-Injector for Self-Injecting Biologics: A Narrative Review

“…Research into biologic therapies for rheumatoid arthritis suggests that adherence is influenced by various patient factors including age and socioeconomic factors [ 15 ]. For example, older patients seem more likely than younger patients to have high adherence [ 38 – 40 ], and more ownership of self-managing medications may also improve adherence [ 41 ]. Adverse factors contributing to non-adherence include stress at home, and unemployment [ 40 ].…”

“…For example, older patients seem more likely than younger patients to have high adherence [ 38 – 40 ], and more ownership of self-managing medications may also improve adherence [ 41 ]. Adverse factors contributing to non-adherence include stress at home, and unemployment [ 40 ].…”

Tailoring Rheumatoid Arthritis Treatment through a Sex and Gender Lens

“…The social process also affects gender differences in adherence to treatment and illness perception. In a cross-sectional study of 320 RA patients, nonadherence was significantly associated with stress, disease activity, functional measures, and deformity, and female gender was an independent predictor of nonadherent behavior and more negative illness perception [ 71 ].…”