Electronically monitored adherence to medications by newly diagnosed patients with juvenile rheumatoid arthritis.
OBJECTIVE
To describe patterns of adherence to nonsteroidal antiinflammatory drugs (NSAIDs) in newly diagnosed patients with juvenile rheumatoid arthritis (JRA), and to examine demographic and disease-related variables as potential predictors of adherence.


METHODS
Adherence to NSAIDs was monitored in 48 children with JRA (mean age 8.6 years) over 28 consecutive days using an electronic monitoring device. Measures of disease activity (active joint counts, morning stiffness) and demographics (age, sex, ethnicity, socioeconomic status) were also obtained.


RESULTS
Using an 80% adherence cut point, 25 (52%) patients were classified as adherent and 23 (48%) as nonadherent. There was considerable variability across patients, with full adherence (taking all doses on time) ranging from 0 to 100% of the monitored days. Logistic regression showed that active joint count and socioeconomic status were the only significant predictors. Both were positively related to adherence. The model correctly classified 70.5% of patients as either adherent or nonadherent (Cox and Snell R(2) = 0.295, P = 0.0005).


CONCLUSIONS
Children newly diagnosed with JRA are more likely to adhere to an NSAID regimen if they have a greater number of active joints or their families have higher socioeconomic status. The former finding suggests that children's adherence is symptom-driven, while the latter suggests that families of lower socioeconomic status deserve special attention to address adherence issues.
Rapoff
Michael A
MA
University of Kansas Medical Center, Kansas City, KS 66160-7330, USA. mrapoff@kumc.edu
Belmont
John M
JM
Lindsley
Carol B
CB
Olson
Nancy Y
NY
D000293:Adolescent; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D016903:Drug Monitoring / Q000379:methods*; D004581:Electronics; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D010349:Patient Compliance; D012720:Severity of Illness Index; D012923:Social Class
D000894:Anti-Inflammatory Agents, Non-Steroidal; D018501:Antirheumatic Agents