Evaluation of Adherence to Drug Treatment in Patients with Rheumatoid Arthritis

Abstract

Rheumatoid arthritis (RA) is one of the most common chronic diseases, with an estimated global prevalence of 1%, characterized by joint inflammation that commonly leads to irreversible joint damage. The resultant pain and joint damage leads to increasingly limited mobility and reduced quality of life. Disease modifying antirheumatic drugs (DMARDs) are the mainstay of RA therapy. The impact of adherence to DMARD may be considerable; adherent patients have more favorable outcomes, including better disease control, higher remission rates and improved physical function, as well as lower rates of disease progression and escalation to further aggressive treatment. The present study was prospective cohort study for 6months included 100 RA patients diagnosed according to the American College of Rheumatology / European League Against Rheumatism collaborative initiative (ACR/ EULAR) to measure the frequency of the adherence in RA patients, and evaluate the common factors influencing RA patients adherence to drug treatment aiming at improving disease outcome. In the present study, the baseline adherence rate was 37% which is lowest adherence rate measured within different studies assessing adherence to treatment in RA. As regard the sociodemographic characteristics of patients, the nonadherent patients were older, living outside Cairo, with low educational level and smokers. The sex, social status, presence of children, occupation, the economic level and presence of other comorbidity had no significant association with the adherence. As regard the clinical characteristic of the RA patients, the nonadherent patients had higher disease activity, more functional disability, as there was significant difference between the adherent and nonadherent as regard the duration of morning stiffness, number of tender joints, DAS28, HAQ score. There was no significant difference between the adherent and non-adherent as regard extra articular manifestations, although non adherent patients were having more susceptibility to presence of rheumatoid nodule, mononeuritis multiplex and vasculitic rash. The laboratory and radiological investigation confirmed the previous finding. The nonadherent patients had higher ESR, CRP titer and more frequentactive synovitis in Doppler ultrasound. ACPA titer in our study was significantly higher in the nonadherent patients. We tried to detect the factors affecting the adherence to RA medications. We found that the cost of medication (61%), non-availability of medication in pharmacy (58%), false believes in the benefit of treatment (38%), forgettfulness the medication (36%), inadequate follow up (23%) and polypharmacy (medication load) (20%) werethe most common factors in nonadherent patients.