title: Adherence rates and associations with nonadherence in patients with rheumatoid arthritis using disease modifying antirheumatic drugs.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pharmacy, Sint Maartenskliniek, PO Box 9011, 6500 GM Nijmegen, The Netherlands. b.vandenbemt@maartenskliniek.nl
authors.forename: Bart J F
authors.initials: BJ
authors.lastname: van den Bemt
authors.forename: Frank H J
authors.initials: FH
authors.lastname: van den Hoogen
authors.forename: Bart
authors.initials: B
authors.lastname: Benraad
authors.forename: Yechiel A
authors.initials: YA
authors.lastname: Hekster
authors.forename: Piet L C M
authors.initials: PL
authors.lastname: van Riel
authors.forename: Wim
authors.initials: W
authors.lastname: van Lankveld
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology*; D003071:Cognition; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology*; D017060:Patient Satisfaction; D012650:Self Disclosure
chemical_list: D018501:Antirheumatic Agents