Hill Jackie
Academic and Clinical Unit for Musculoskeletal Nursing, University of Leeds, Leeds, UK.
Musculoskeletal Care. 2005;3(2):61-73. doi: 10.1002/msc.27.
Drug therapy plays a major role in the management of many rheumatic diseases and is particularly important in rheumatoid arthritis (RA) because of the significant rates of morbidity and mortality (Pincus, 1995). Understanding of the pathogenesis of RA has led to the development of new and more effective drugs (Emery et al., 1999), but the ultimate efficacy of any drug therapy depends upon the patient's decision to take it. There is widespread agreement that many people with rheumatic disease do not adhere to their medication regimens (Deyo et al., 1981; Belcon et al., 1984; Pullar et al., 1988; Hill et al., 2001). Research has demonstrated that 50% of women taking hormone replacement therapy for the prevention of osteoporosis discontinue treatment after a year (Fordham, 2000) and similar rates of discontinuation are found in other chronic diseases (Haynes et al., 1996, 2000). This is bewildering as, in asymptomatic illnesses such as hypertension and diabetes, the expectation is that levels of adherence would be lower than in diseases where pain and stiffness are present. The picture becomes even more confusing when we consider the findings from a recent multi-country study of RA, which found no association between adherence and disease severity, nor with the treatment prescribed (Viller et al., 1999). In chronic disease poor adherence is commonplace. The World Health Organization (WHO) recognizes this and has recently stated that 'poor adherence to treatment of chronic diseases is a worldwide problem of striking magnitude' and cites adherence to long-term therapy for chronic illnesses in developed countries averaging just 50% (WHO, 2003). The first part of this two part review focuses on adherence with drug therapy, and the second part discusses different methods of measuring it.
药物治疗在许多风湿性疾病的管理中起着重要作用，在类风湿关节炎（RA）中尤为重要，因为其发病率和死亡率都很高（平卡斯，1995年）。对RA发病机制的了解促使了更新、更有效的药物的研发（埃默里等人，1999年），但任何药物治疗的最终疗效都取决于患者服药的意愿。人们普遍认为，许多患有风湿性疾病的人不坚持他们的药物治疗方案（德约等人，1981年；贝尔孔等人，1984年；普拉尔等人，1988年；希尔等人，2001年）。研究表明，50%接受激素替代疗法预防骨质疏松症的女性在一年后停止治疗（福特姆，2000年），其他慢性病也有类似的停药率（海恩斯等人，1996年、2000年）。这令人困惑，因为在诸如高血压和糖尿病等无症状疾病中，人们预计依从性水平会低于存在疼痛和僵硬症状的疾病。当我们考虑最近一项关于RA的多国研究结果时，情况变得更加复杂，该研究发现依从性与疾病严重程度以及所开的治疗方法均无关联（维勒等人，1999年）。在慢性病中，依从性差很常见。世界卫生组织（WHO）认识到这一点，最近指出“慢性病治疗依从性差是一个全球性的严重问题”，并指出发达国家慢性病长期治疗的依从性平均仅为50%（WHO，2003年）。本综述分为两部分，第一部分聚焦于药物治疗的依从性，第二部分讨论测量依从性的不同方法。
