, Volume 25, Issue 4, pp 431–438 | Cite as

Effects of antirheumatic drug underutilization on rheumatoid arthritis disease activity

  • Mohammad A. Y. Alqudah
  • Sayer Al-azzam
  • Karem Alzoubi
  • Mohammad Alkhatatbeh
  • Khaldoon Alawneh
  • Ola Alazzeh
  • Bayan Ababneh
Original Article



Following the recommended guidelines is crucial for achieving patient remission in rheumatoid arthritis. The aim of this study was to assess the effect of proper drug utilization of antirheumatic drugs on disease activity and drug safety in Jordan.


In a retrospective cross-sectional study, patient’s demographics, clinical variables, drug regimens and side effects were recorded and the 28-joint disease activity scores were calculated. Patients were stratified into high, moderate, low disease activity or remission group.


Around 80% of patients were using methotrexate which was under-dosed in 82% of them. Only 25% were using biologic drugs. Surprisingly, only 10% of patients had low disease activity and only 4% were in a remission state. Anaemia (32.3%) and mild renal impairment (27.6%) were the most common side effects.


The low frequency of well-controlled disease activity is interpreted by high occurrence of methotrexate underdosing and biologic agent underprescription. Implementing the role of a clinical pharmacist could have a real impact on tight control of such disease issues in Jordan.


Rheumatoid arthritis DMARDs Biologic agents Disease activity Underdosing Underprescription Side effects 



Rheumatoid arthritis


Disease-modifying antirheumatic drugs


The 28-joint disease activity score


American College of Rheumatology


European League Against Rheumatism




C-reactive protein




Tumour-necrosis factor


Compliance with ethical standards

Conflict of interest

The authors have declared that no competing interests exist.


This work was supported by the Deanship of Research at Jordan University of Science and Technology. The contents of this publication are solely the responsibility of the authors and the funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.


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Copyright information

© Springer International Publishing 2017

Authors and Affiliations

  • Mohammad A. Y. Alqudah
    • 1
  • Sayer Al-azzam
    • 1
  • Karem Alzoubi
    • 1
  • Mohammad Alkhatatbeh
    • 1
  • Khaldoon Alawneh
    • 2
  • Ola Alazzeh
    • 1
  • Bayan Ababneh
    • 1
  1. 1.Department of Clinical Pharmacy, Faculty of PharmacyJordan University of Science and TechnologyIrbidJordan
  2. 2.Department of Internal Medicine, Faculty of MedicineJordan University of Science and TechnologyIrbidJordan

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