Department of Pharmacy, Sint Maartenskliniek, PO Box 9011, 6500 GM Nijmegen, The Netherlands.
J Rheumatol. 2009 Oct;36(10):2164-70. doi: 10.3899/jrheum.081204. Epub 2009 Sep 1.
Nonadherence in patients with rheumatoid arthritis (RA) using disease modifying antirheumatic drugs (DMARD) may result in unnecessarily high levels of disease activity and function loss. The aim of this descriptive study was to assess adherence rates with self-report measures in a large random population, and to identify potential risk factors for nonadherence.
A randomly selected sample of 228 patients with RA using DMARD was invited for a standardised interview. For each medicine, the patients were asked about adherence, consumption and perceived (side) effects. After the interview, the patients received self-report questionnaires to assess adherence [Compliance Questionnaire on Rheumatology (CQR) and the Medication Adherence Scale (MARS)], coping, beliefs about medicines, satisfaction about medicine information, and physical functioning. Subsequently, associations between adherence and demographics, clinical characteristics, and patient attitudes were examined.
Depending on the instrument used, 68% (CQR) and 60% (MARS) of the patients were adherent to DMARD. Nonadherence was not associated with demographic and clinical characteristics, satisfaction about information, medication concerns, and coping styles. The disease duration, the number of perceived side-effects, and beliefs about the necessity of the medicine were weakly associated with adherence.
In this large study with a random RA population, 32%-40% of the patients did not adhere to their DMARD prescription. As none of the possible risk factors was strongly related to adherence, no general risk factor seems to be powerful enough as a possible screening tool or target for adherence-improving interventions. This implies that nonadherence barriers should be assessed on an individual basis.
类风湿关节炎（RA）患者使用疾病修饰抗风湿药物（DMARD）不依从可能导致疾病活动度和功能丧失不必要地升高。本描述性研究的目的是评估使用自我报告措施在大型随机人群中的依从率，并确定不依从的潜在危险因素。
随机选择了 228 名使用 DMARD 的 RA 患者进行标准访谈。对于每种药物，患者被问及依从性、消耗和感知（副作用）。访谈后，患者收到自我报告问卷以评估依从性[风湿病依从性问卷（CQR）和药物依从性量表（MARS）]、应对、对药物的信念、对药物信息的满意度和身体功能。随后，检查了依从性与人口统计学、临床特征和患者态度之间的关联。
根据使用的仪器，68%（CQR）和 60%（MARS）的患者对 DMARD 依从。不依从与人口统计学和临床特征、信息满意度、药物担忧和应对方式无关。疾病持续时间、感知副作用的数量和对药物必要性的信念与依从性呈弱相关。
在这项针对随机 RA 人群的大型研究中，32%-40%的患者未按处方服用 DMARD。由于没有一个可能的危险因素与依从性有很强的相关性，因此没有一个普遍的危险因素似乎强大到足以作为可能的筛选工具或依从性改善干预的目标。这意味着应该在个体基础上评估不依从的障碍。
