title: Medication adherence in patients with rheumatoid arthritis: the effect of patient education, health literacy, and musculoskeletal ultrasound.
abstract: BACKGROUND
  Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease affecting <1% of the population. Incompletely controlled RA results in fatigue, joint and soft tissue pain, progressive joint damage, reduced quality of life, and increased cardiovascular mortality. Despite an increasing range of disease modifying agents which halt disease progression, poor patient adherence with medication is a significant barrier to management.
  
  
  OBJECTIVE
  The goal of this review was to examine the effectiveness of measures to improve patient medication adherence.
  
  
  METHODS
  Studies addressing treatment adherence in patients with RA were identified by trawling PsycINFO, Medline, Cochrane, Pubmed, and ProQuest for studies published between January 2000 and October 2014. Articles were independently reviewed to identify relevant studies.
  
  
  RESULTS
  Current strategies were of limited efficacy in improving patient adherence with medications used to treat RA.
  
  
  CONCLUSIONS
  Poor medication adherence is a complex issue. Low educational levels and limited health literacy are contributory factors. Psychological models may assist in explaining medication nonadherence. Increasing patient knowledge of their disease seems sensible. Existing educational interventions appear ineffective at improving medication adherence, probably due to an overemphasis on provision of biomedical information. A novel approach to patient education using musculoskeletal ultrasound is proposed.
authors.affiliation: School of Psychology, University of Sydney, Sydney, NSW 2006, Australia.
authors.forename: Samantha
authors.initials: S
authors.lastname: Joplin
authors.affiliation: Department of Psychology, Southern Cross University, Coffs Harbour, NSW 2450, Australia.
authors.forename: Rick
authors.initials: R
authors.lastname: van der Zwan
authors.affiliation: Department of Rheumatology, Prince of Wales Hospital, Randwick, Sydney, NSW 2031, Australia ; Prince of Wales Hospital Clinical School, University of New South Wales, Randwick, Sydney, NSW 2031, Australia.
authors.forename: Fredrick
authors.initials: F
authors.lastname: Joshua
authors.affiliation: Mid-North Coast Arthritis Clinic, Coffs Harbour, NSW 2450, Australia ; Rural Clinical School, University of New South Wales, Coffs Harbour, NSW 2450, Australia.
authors.forename: Peter K K
authors.initials: PK
authors.lastname: Wong
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000523:psychology; D057220:Health Literacy; D006801:Humans; D055118:Medication Adherence / Q000523:psychology; D008960:Models, Psychological; D009141:Musculoskeletal System / Q000000981:diagnostic imaging; D010353:Patient Education as Topic / Q000379:methods; D014463:Ultrasonography; D016903:Drug Monitoring
chemical_list: D018501:Antirheumatic Agents