The causes of non-adherence to methotrexate in patients with rheumatoid arthritis

Abstract

Background: Rheumatoid arthritis (RA) is a chronic progressive autoimmune inflammatory systemic disease; methotrexate is the first drug of choice to retard the disease progression. Objective: To elucidate the main factors that leading to non-adherence to methotrexate in patients with rheumatoid arthritis. Method: In this cross-sectional study, one hundred twenty-two (122) patients diagnosed with RA > 18 years old on methotrexate (mono or combined therapy) for at least three months. Data were recorded including demographic data, socioeconomic status, education level, disease duration, duration of methotrexate therapy, current weekly methotrexate dose, concomitant drugs, and factors might contribute to non-adherence. Non-adherence was considered when three or more of weekly dose of methotrexate were omitted in the last 8 weeks. Results: 38 patients (31.14%) were non-adherent. Patients with longer disease duration, those with higher education level, and on concomitant steroid had higher rate of non-adherence. Among the factors contributing to non-adherence are: Methotrexate Don't treat arthritis symptoms well 25 patients (65.78%), social myths 24 patients (63.15%), Don't need it when feeling well: 22 patients (57.89%) were on the top of list. Conclusion: The patients with non-adherence in the current study constitute about one third of the patients. Good adherence rate can increase by good doctor-patients communication and continuous patients’ education and counseling by treating rheumatologist.