title: Glucocorticoids in systemic sclerosis: patients' beliefs and treatment adherence.
abstract: OBJECTIVE
  To investigate how chronic intake of glucocorticoids (GCs) is perceived by patients with systemic sclerosis (SSc) in terms of necessity and concerns, and whether such beliefs influence treatment adherence.
  
  
  METHODS
  Ninety-eight consecutive SSc patients who they had been taking oral GCs for > 3 months prior to the study were enrolled. All patients underwent a clinical evaluation and laboratory investigations, and were asked to complete four self-administered questionnaires: the Beliefs about Medicines Questionnaire (Specific-BMQ), the four-item Morisky Medication Adherence Scale (MMAS-4), the 36-item Short Form Health Survey (SF-36), and the Health Assessment Questionnaire Disability Index (HAQ-DI). Moreover, patients answered two additional questions investigating their knowledge about GC-related adverse events (AEs).
  
  
  RESULTS
  Seventy-seven patients (83.6%) believed in the necessity of GCs for maintaining health but 72.8% also reported concerns about potential AEs to GCs. A high adherence rate was recorded in 64.1% of patients. Only about 20% of patients reported knowing that a daily GC dose and treatment duration influence the burden of GC-related AEs. Patients who believed that GC-related AEs were influenced by the dose scored lower concerns (p = 0.043) and were more frequently labelled as accepting (perceiving high necessity and low concerns) (p = 0.009).
  
  
  CONCLUSIONS
  The majority of patients taking GCs perceived them as necessary, but high concerns about chronic GC use exist. Patients with a poorer knowledge of the factors associated with GC-related AEs and those with a poorer quality of life were the most worried about these compounds. Experimental studies assessing the efficacy of educational programmes aiming to increase the adherence to GC therapy should be planned in these patients.
authors.affiliation: Rheumatology Unit, Second University of Naples , Italy.
authors.forename: M
authors.initials: M
authors.lastname: Iudici
authors.forename: B
authors.initials: B
authors.lastname: Russo
authors.forename: M
authors.initials: M
authors.lastname: Mitidieri
authors.forename: G
authors.initials: G
authors.lastname: Cuomo
authors.forename: G
authors.initials: G
authors.lastname: Valentini
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011788:Quality of Life; D012595:Scleroderma, Systemic / Q000188:drug therapy*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
chemical_list: D005938:Glucocorticoids