Assessment of adherence to disease-modifying anti-rheumatic drugs in rheumatoid arthritis

  • Clélia Monchablon
  • Henri GondéEmail author
  • Sophie Pouplin
  • Rémi Varin
  • Olivier Vittecoq
  • Thierry Lequerré
Original Article



This work aimed to assess treatment adherence in rheumatoid arthritis patients with several tools and to identify factors associated with poor adherence.


Between February and December 2015, 183 patients were included in this cross-sectional study. A homemade 23-item self-questionnaire was filled by patients during an outpatient consultation or a day hospitalization stay. Morisky Medication Adherence Scale (MMAS)-4, MMAS-8 and Girerd scores were extracted from this homemade questionnaire. Medication possession ratio (MPR) was then calculated. For identification of factors associated with nonadherence, patients were divided in two groups according to MMAS-8 results differentiating patients with good or bad adherence to treatments.


Of the 183 patients, 59% received a combination of biologic and conventional synthetic disease-modifying drugs, 22% a biological treatment alone, and 19% a conventional DMARD alone. Respectively, 3%, 10%, and 7% were considered as low adherent according to MMAS-4, MMAS-8, and Girerd scores. MPR was calculated for 84/183 patients; 23% were low adherent. The need for a help in preparing the drugs (p = 0.05; OR = 6.12; 95% CI: 0.86 to 268.90) and concomitant diabetes (p < 0.001; OR = 0.045, 95% CI: 0.001 to 0.299) was higher in patients with good adherence. Presence of a patient’s relative reminding to take medications was associated with low adherence (p = 0.002; OR = 4.32, 95% CI: 1.41 to 13.11).


This study highlighted the difficulty of assessing treatment adherence in rheumatoid arthritis patients despite four different tools. Objective measures by MPR indicated a higher proportion of poor adherent patients than self-questionnaires.

Key Points

Proportion of patients considered as low adherent ranged from 3 to 27% according to the method of evaluation.

The use of a pillbox and/or the preparation of drugs by a patient’s relative was associated with good adherence.

The presence of a patient’s relative reminding to take medication was associated with low adherence.


Adherence Medication Questionnaire Rheumatoid arthritis 


Compliance with ethical standards

Conflict of interest

T.L. has received research grants and/or honoraria from AbbVie, Amgen, BMS, Lilly, MSD, Novartis, Pfizer, Sanofi Aventis, and UCB. Other authors do not declare conflicts of interest.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Supplementary material

10067_2019_4837_MOESM1_ESM.pdf (169 kb)
ESM 1 (PDF 168 kb)


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Copyright information

© International League of Associations for Rheumatology (ILAR) 2019

Authors and Affiliations

  • Clélia Monchablon
    • 1
  • Henri Gondé
    • 2
    Email author
  • Sophie Pouplin
    • 3
  • Rémi Varin
    • 2
  • Olivier Vittecoq
    • 4
  • Thierry Lequerré
    • 4
  1. 1.Department of PharmacyRouen University HospitalRouen CedexFrance
  2. 2.Normandie Univ, UNIROUEN, U1234 Inserm, Department of PharmacyRouen University HospitalRouen CedexFrance
  3. 3.Department of RheumatologyRouen University HospitalRouen CedexFrance
  4. 4.Normandie Univ, UNIROUEN, U1234 Inserm, Department of RheumatologyRouen University HospitalRouen CedexFrance

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