Abstract
Rheumatoid arthritis (RA) is an autoimmune inflammatory disease which results in extensive articular and extra-articular morbidity and increased mortality from cardiovascular disease. Despite an increasing range of non-biological and biological disease-modifying agents, poor patient adherence with medication is a significant barrier to effective control of the inflammation associated with RA. This review seeks to identify factors that affect patient adherence with medication, examine the effectiveness of interventions to address this issue and offer practical suggestions to improve medication adherence. The impact of health literacy on medication adherence and the novel role of musculoskeletal ultrasound as an educational intervention will also be discussed.
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References
Scott DL, Wolfe F, Huizinga TW (2010) Rheumatoid arthritis. Lancet 376:1094–1108
Elliott RA (2008) Poor adherence to medication in adults with rheumatoid arthritis: reasons and solutions. Dis Manag Health Outcomes 16:13–29
Escalas C, Dalichampt M, Combe B, Fautrel B, Guillemin F, Durieux P, Dougados M, Ravaud P (2012) Effect of adherence to European treatment recommendations on early arthritis outcome: data from the ESPOIR cohort. Ann Rheum Dis 71:1803–1808
Singh JA, Saag KG, Bridges SL Jr, Akl EA, Bannuru RR, Sullivan MC, Vaysbrot E, McNaughton C, Osani M, Shmerling RH, Curtis JR, Furst DE, Parks D, Kavanaugh A, O’Dell J, King C, Leong A, Matteson EL, Schousboe JT, Drevlow B, Ginsberg S, Grober J, St Clair EW, Tindall E, Miller AS, McAlindon T (2016) 2015 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Rheum 68:1–26
van den Bemt B, van Lankveld W (2007) How can we improve adherence to therapy by patients with rheumatoid arthritis? Nat Clin Prac Rheum 3:681
van den Bemt B, Zwikker H, van den Ende C (2012) Medication adherence in patients with rheumatoid arthritis: a critical appraisal of the existing literature. Exp Rev Clin Immunol 8:337–351
Curkendall S, Patel V, Gleeson M, Campbell RS, Zagari M, Dubois R (2008) Compliance with biologic therapies for rheumatoid arthritis: do patient out-of-pocket payments matter? Arthritis Rheum 59:1519–1526
Fallis BA, Dhalla IA, Klemensberg J, Bell CM (2013) Primary medication non-adherence after discharge from a general internal medicine service. PLoS One 8:e61735
Pascual-Ramos V, Contreras-Yáñez I, Villa AR, Cabiedes J, Rull-Gabayet M (2009) Medication persistence over 2 years of follow-up in a cohort of early rheumatoid arthritis patients: associated factors and relationship with disease activity and with disability. Arthritis Res Ther 11:R26
Hovstadius B, Petersson G (2011) Non-adherence to drug therapy and drug acquisition costs in a national population—a patient-based register study. BMC Health Serv Res 11:326
De Vera MA (2014) Economics of non-adherence to biologic therapies in rheumatoid arthritis. Curr Rheum Rep 16:460
Viller F, Guillemin F, Briançon S, Moum T, Suurmeijer T, van den Heuvel W (1999) Compliance to drug treatment of patients with rheumatoid arthritis: a 3 year longitudinal study. J Rheumatol 26:2114–2122
Tuncay R, Eksioglu E, Cakir B, Gurcay E, Cakci A (2007) Factors affecting drug treatment compliance in patients with rheumatoid arthritis. Rheum Int 27:743–746
Salt E, Frazier SK (2011) Predictors of medication adherence in patients with rheumatoid arthritis. Drug Dev Res 72:756–763
van den Bemt B, van den Hoogen F, Benraad B, Hekster Y, van Riel Y, van Lankveld W (2009) Adherence rates and associations with nonadherence in patients with rheumatoid arthritis using disease modifying antirheumatic drugs. J Rheumatol 36:2164–2170
Treharne GJ (2004) Medication adherence in rheumatoid arthritis: effects of psychosocial factors. Psychol Health Med 9:337–349
de Thurah A, Nørgaard M, Harder I, Stengaard-Pedersen K (2010) Compliance with methotrexate treatment in patients with rheumatoid arthritis: influence of patients’ beliefs about the medicine. A prospective cohort study. Rheum Int 30:1441–1448
Morgan C, McBeth J, Cordingley L, Watson K, Hyrich KL, Symmons DP, Bruce IN (2015) The influence of behavioural and psychological factors on medication adherence over time in rheumatoid arthritis patients: a study in the biologics era. Rheumatology (Oxford) 54:1780–1791
Hill J, Bird H, Johnson S (2001) Effect of patient education on adherence to drug treatment for rheumatoid arthritis: a randomised controlled trial. Ann Rheum Dis 60:869–875
Müller R, Kallikorm R, Põlluste K, Lember M (2012) Compliance with treatment of rheumatoid arthritis. Rheum Int 32:3131–3135
Salt E, Peden A (2011) The complexity of the treatment: the decision-making process among women with rheumatoid arthritis. Qual Health Res 21:214–222
Kristensen LE, Saxne T, Nilsson JA, Geborek P (2006) Impact of concomitant DMARD therapy on adherence to treatment with etanercept and infliximab in rheumatoid arthritis. Results from a six-year observational study in southern Sweden. Arthritis Res Ther 8:R174
Borah BJ, Huang X, Zarotsky V, Globe D (2009) Trends in RA patients’ adherence to subcutaneous anti-TNF therapies and costs. Curr Med Res Opin 25:1365–1377
Poulos C, Hauber AB, González JM, Turpcu A (2014) Patients’ willingness to trade off between the duration and frequency of rheumatoid arthritis treatments. Arthritis Care Res (Hoboken) 66:1008–1015
Tkacz J, Ellis L, Bolge SC, Meyer R, Brady BL, Ruetsch C (2014) Utilization and adherence patterns of subcutaneously administered anti-tumor necrosis factor treatment among rheumatoid arthritis patients. Clin Ther 36:737–747
Wong M, Mulherin D (2007) The influence of medication beliefs and other psychosocial factors on early discontinuation of disease-modifying anti-rheumatic drugs. Musculoskelet Care 5:148–159
Mjaavatten MD, Radner H, Yoshida K, Shadick NA, Frits ML, Iannaccone CK, Kvien TK, Weinblatt ME, Solomon DH (2014) Inconsistent treatment with disease-modifying antirheumatic drugs: a longitudinal data analysis. J Rheumatol 41:2370–2378
Neame R, Hammond A (2005) Beliefs about medications: a questionnaire survey of people with rheumatoid arthritis. Rheumatology (Oxford) 44:762–767
Goodacre LJ, Goodacre JA (2004) Factors influencing the beliefs of patients with rheumatoid arthritis regarding disease-modifying medication. Rheumatology (Oxford) 43:583–586
de Thurah A, Nørgaard M, Johansen MB, Stengaard-Pedersen K (2010) Methotrexate compliance among patients with rheumatoid arthritis: the influence of disease activity, disease duration, and co-morbidity in a 10-year longitudinal study. Scand J Rheum 39:197–205
Contreras-Yáñez PonceDe, León S, Cabiedes J, Rull-Gabayet M, Pascual-Ramos V (2010) Inadequate therapy behavior is associated to disease flares in patients with rheumatoid arthritis who have achieved remission with disease-modifying antirheumatic drugs. Am J Med Sci 340:282–290
Pascual-Ramos V, Contreras-Yáñez I (2013) Motivations for inadequate persistence with disease modifying anti-rheumatic drugs in early rheumatoid arthritis: the patient’s perspective. BMC Musculoskelet Disord 14:336
Joplin S, van der Zwan R, Joshua F, Wong PK (2015) Medication adherence in patients with rheumatoid arthritis: the effect of patient education, health literacy, and musculoskeletal ultrasound. Biomed Res Int 2015:150658. doi:10.1155/2015/150658 (Epub 2015 Apr 28)
http://www.rheumatology.org.au/community/PatientMedicineInformation.asp
http://www.rheumatology.org/i-am-a/patient-caregiver/treatments
http://www.rheumatology.org.uk/patient_information/patient_information/
Li P, Blum MA, Von Feldt J, Hennessy S, Doshi JA (2010) Adherence, discontinuation, and switching of biologic therapies in medicaid enrollees with rheumatoid arthritis. Value Health 13:805–812
Pasma A, van’t Spijker A, Hazes JM, Busschbach JJ, Luime JJ (2013) Factors associated with adherence to pharmaceutical treatment for rheumatoid arthritis patients: a systematic review. Semin Arthritis Rheum 43:18–28
Ho M, Lavery B, Pullar T (1998) The risk of treatment. A study of rheumatoid arthritis patients’ attitudes. Br J Rheum 37:459–460
Berry D, Bradlow A, Bersellini E (2004) Perceptions of the risks and benefits of medicines in patients with rheumatoid arthritis and other painful musculoskeletal conditions. Rheumatology (Oxford) 43:901–905
Brus H, van de Laar MA, Taal E, Rasker JJ, Wiegman O (1998) Effects of patient education on compliance with basic treatment regimens and health in recent onset active rheumatoid arthritis. Ann Rheum Dis 57:146–151
Niedermann K, Fransen J, Knols R, Uebelhart D (2004) Gap between short- and long-term effects of patient education in rheumatoid arthritis patients: a systematic review. Arthritis Rheum 51:388–398
Zwikker HE, van den Ende CH, van Lankveld WG, den Broeder AA, van den Hoogen FH, van de Mosselaar B, van Dulmen S, van den Bemt BJ (2014) Effectiveness of a group-based intervention to change medication beliefs and improve medication adherence in patients with rheumatoid arthritis: a randomized controlled trial. Patient Educ Couns 94:356–361
Horne R, Weinman J (1999) Patients’ beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. J Psychosom Res 47:555–567
Treharne GJ, Lyons AC, Hale ED, Douglas KM, Kitas GD (2006) ‘Compliance’ is futile but is ‘concordance’ between rheumatology patients and health professionals attainable? Rheumatology (Oxford) 45:1–5
Australian Government (1991) Department of education employment and training. The Australian language and literacy policy. Australian Government, Canberra
Nutbeam D (2008) The evolving concept of health literacy. Soc Sci Med 67:2072–2078
Adams RJ, Appleton SL, Hill CL, Ruffin RE, Wilson DH (2009) Inadequate health literacy is associated with increased asthma morbidity in a population sample. J Allergy Clin Immunol 124:601–603
Rosas-Salazar C, Apter AJ, Canino G, Celedón JC (2012) Health literacy and asthma. J Allergy Clin Immunol 129:935–942
Schillinger D, Grumbach K, Piette J, Wang F, Osmond D, Daher C, Palacios J, Sullivan GD, Bindman AB (2002) Association of health literacy with diabetes outcomes. JAMA 288:475–482
Cavanaugh K, Huizinga MM, Wallston KA, Gebretsadik T, Shintani A, Davis D, Gregory RP, Fuchs L, Malone R, Cherrington A, Pignone M, DeWalt DA, Elasy TA, Rothman RL (2008) Association of numeracy and diabetes control. Ann Intern Med 148:737–746
Estrada CA, Martin-Hryniewica M, Peek BT, Collins C, Byrd JC (2004) Literacy and numeracy skills and anticoagulation control. Am J Med Sci 328:88–93
Baker DW, Wolf MS, Feinglass J, Thompson JA, Gazmararian JA, Huang J (2007) Health literacy and mortality among elderly persons. Arch Intern Med 167:1503–1509
Sudore RL, Yaffe K, Satterfield S, Harris TB, Mehta KM, Simonsick EM, Newman AB, Rosano C, Rooks R, Rubin SM, Ayonayon HN, Schillinger D (2006) Limited literacy and mortality in the elderly: the health, aging, and body composition study. J Gen Intern Med 21:806–812
Miles S, Davis TC (1995) Patients who can’t read. Implications for the health care system. JAMA 274:1719–1720
American Medical Association (1999) Ad hoc committee on health literacy for the council on scientific affairs, health literacy: report of the council on scientific affairs. JAMA 281:552–557
Adams RJ (2010) Improving health outcomes with better patient understanding and education. J Risk Manag Health Care Policy 3:61–72
Caplan L, Wolfe F, Michaud K, Quinzanos I, Hirsh JM (2014) Strong association of health literacy with functional status among rheumatoid arthritis patients: a cross-sectional study. Arthritis Care Res (Hoboken) 66:508–514
Wong PK, Christie L, Johnston J, Bowling A, Freeman D, Joshua F, Bird P, Chia K, Bagga H (2014) How well do patients understand written instructions?: health literacy assessment in rural and urban rheumatology outpatients. Medicine (Baltimore) 93(25):e129. doi:10.1097/MD.0000000000000129
Buchbinder R, Hall S, Youd JM (2006) Functional health literacy of patients with rheumatoid arthritis attending a community-based rheumatology practice. J Rheumatol 33:879–886
Swearingen CJ, McCollum BA, Daltroy LH, Pincus T, Dewalt DA, Davis TC (2010) Screening for low literacy in a rheumatology setting: more than 10% of patients cannot read “cartilage,” “diagnosis,” “rheumatologist,” or “symptom”. J Clin Rheumatol 16:359–364
Gordon MM, Hampson R, Capell HA, Madhok R (2002) Illiteracy in rheumatoid arthritis patients as determined by the Rapid Estimate of Adult Literacy in Medicine (REALM) score. Rheumatology (Oxford) 41:750–754
Buchbinder R, Hall S, Grant G, Mylvaganam A, Patrick MR (2001) Readability and content of supplementary written drug information for patients used by Australian rheumatologists. Med J Aust 174:575–578
Hirsh JM, Boyle DJ, Collier DH, Oxenfeld AJ, Nash A, Quinzanos I, Caplan L (2011) Limited health literacy is a common finding in a public health hospital’s rheumatology clinic and is predictive of disease severity. J Clin Rheum 17:236–241
Katz MG, Kripalani S, Weiss BD (2006) Use of pictorial aids in medication instructions: a review of the literature. Am J Health Syst Pharm 63:2391–2397
El Miedany Y, El Gaafary M, Palmer D (2012) Assessment of the utility of visual feedback in the treatment of early rheumatoid arthritis patients: a pilot study. Rheum Int 32:3061–3068
Joplin SK, van der Zwan R, Bagga H, Joshua F, Wong PK (2014) Pilot study assessing the novel use of musculoskeletal ultrasound in patients with rheumatoid arthritis to improve patient attitudes and adherence to medication. Int J Rheum Dis. doi:10.1111/1756-185X.12402
Kumar K, Raza K, Gill P, Greenfield S (2016) The impact of using musculoskeletal ultrasound imaging and other influencing factors on medication adherence in patients with rheumatoid arthritis: a qualitative study. Patient Prefer Adherence 10:1091–1100
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Wong, P.K.K. Medication adherence in patients with rheumatoid arthritis: why do patients not take what we prescribe?. Rheumatol Int 36, 1535–1542 (2016). https://doi.org/10.1007/s00296-016-3566-4
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DOI: https://doi.org/10.1007/s00296-016-3566-4