Evaluation of Adherence to Drug Treatment in Patients with Rheumatoid Arthritis

Abstract

Background: the medication adherence is very vital issue nowadays, especially in RA patients. Objective(s): 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. Method(s): a Prospective cohort study of 100 patients with RA under treatment, fulfilled the American College of Rheumatology/European League Against Rheumatism (ACR/ EULAR) (1) criteria. All patients subjected to Full history taking and clinical examination, (DAS 28 ESR), Health Assesment Questionnaire (HAQ) score, Visual Analouge Scalez (VAS) scale, CBC, ESR, CRP titer, RF titer, ACPA titer and Power Doppler U/S for both hands, patients also respond to specific questionnair containing questions about sociodemographic data, medication, health care system and Compliance Questionnaire of Rheumaology (CQR). Result(s): The baseline adherence rate (CQR>=80) was 37%. The nonadherent RA patients to drug treatment were older, living outside Cairo, with low educational level and smokers, they also had higher DAS28ESR score, HAQscore, ESR, CRP titer and more frequent active synovitis in Doppler ultrasound. The cost of medication (61%), non-availability of medication in pharmacy (58%), forgetting the medication (36%), patients' lack of belief in the benefit of treatment (38%), inadequate follow up or discharge planning (23%) and polypharmacy (medication load) (20%) were the most common factors in nonadherent patients table (3). After 9 months of the follow up and trying to correct the causes of nonadherence, the adherence rate increased to (68.75%).Also there was improvement in disease activity, improvement in functional state and improvement in the quality of life. Conclusion(s): Low adherence rate was associated with higher disease activity, functional disability. Patient education, financial support, good physician patient relationship, simplification of the prescription, facilitation their communication, using MSUS were found to improve the patient adherence and improve the disease outcome.