Abstract
Objective:To determine adherence to methotrexate (MTX) therapy in patients with Rheumatoid Arthritis (RA) and to identify factors that promote either adherence or non adherence.Methods:One hundred Rheumatoid Arthritis patients on MTX for at least two months were enrolled. Questionnaire was completed by direct interview. Details recorded were, demographics (age, sex, education, monthly income), disease duration, duration on MTX and current dose. Disease Activity Score on 28 joint counts (DAS 28) at the current visit, concomitant drugs taken and number of doses of MTX missed in the previous 8 weeks were noted. Non adherence was defined as omission of any three or more prescribed doses of MTX in previous 8 week. Patients were asked for the factors that motivated their adherence to MTX as well as factors for non adherence. Presence of side effects due to MTX was also recorded.Result:Non adherence was found among 23% of cases. Patients of low socioeconomic group (p <0.0001) and on MTX for longer duration (p <0.001) had higher non adherence. Non adherent patients had significantly higher disease activity as measured by DAS 28 (p<0.001). Good counseling and education by the doctor was a strong predictor of adherence (p <0.001). Lack of affordability (p <0.001); lack of availability at local pharmacy (p <0.001); lack of family support (p <0.001) and lack of awareness regarding need and importance of MTX (p < 0.001were found as significant factors for non adherence.Conclusion:MTX non adherence in RA is noted in about one fourth of study group. Various economical and social issues lead to non adherence but good patient education and counseling by doctor could promote adherence in this study group.
Highlights
Rheumatoid arthritis (RA) is a chronic systemic auto immune inflammatory disease with a prevalence of approximately 1%.1,2 If untreated, RA leads to severe progressive joint damage, functional disability, morbidity and increase mortality
Insight into the molecular pathogenesis of RA has lead to an increasing number of targeted diseases modifying anti rheumatoid drugs (DMARDs).[3,4]
As in all chronic diseases where compliance to therapy is vital for success of treatment, adherence to MTX is the key to attaining the goal of disease remission or low disease activity.[9]
Summary
Rheumatoid arthritis (RA) is a chronic systemic auto immune inflammatory disease with a prevalence of approximately 1%.1,2 If untreated, RA leads to severe progressive joint damage, functional disability, morbidity and increase mortality. As in all chronic diseases where compliance to therapy is vital for success of treatment, adherence to MTX is the key to attaining the goal of disease remission or low disease activity.[9] Non adherence to treatment may jeopardize patient’s health, cause unnecessary clinic appointments and diagnostic studies as well as additional treatments. These effects increase the cost of medical care and can contribute to increased morbidity and mortality.[10,11] The estimated cost of non adherence to standard treatment in chronic diseases in the US is US hundred billion dollars annually.[10]. This would help guide rheumatologists to modify these factors, thereby increasing adherence to this important anchor drug
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