title: Non-adherence to disease-modifying antirheumatic drugs is associated with higher disease activity in early arthritis patients in the first year of the disease.
abstract: BACKGROUND
  Non-adherence to disease-modifying antirheumatic drugs (DMARDs) hampers the targets of rheumatoid arthritis (RA) treatment, obtaining low disease activity and decreasing radiological progression. This study investigates if, and to what extent, non-adherence to treatment would lead to a higher 28-joint count disease activity score (DAS28) in the first year after diagnosis.
  
  
  METHODS
  Adult patients from an ongoing cohort study on treatment adherence were selected if they fulfilled the EULAR/ACR2010 criteria for RA, and were to start with their first DMARDs. Clinical variables were assessed at baseline and every 3 months. Non-adherence was continuously electronically measured and was defined as the proportion of days with a negative difference between expected and observed openings of the medication container out of the 3-month period before DAS28 measurement. Generalized linear mixed models were used to investigate whether the DAS28 related to non-adherence. Covariates included were age, sex, baseline DAS28, rheumatoid factor positivity, anti-cyclic citrullinated peptide antibodies (ACPA) positivity, anxiety, depression, weeks of treatment, number of DMARDs used, education level, use of subcutaneous methotrexate and biological use.
  
  
  RESULTS
  One hundred and twenty patients met the inclusion criteria for RA. During the study period 17 patients became lost to follow-up. There was a decline in adherence over time for all DMARDs except for prednisone. Non-adherence is a predictor of disease activity in the first 6 months of therapy, adjusted for weeks of treatment, baseline DAS28, and baseline anxiety.
  
  
  CONCLUSIONS
  Non-adherence relates to disease activity. Therefore, interventions towards enhancing adherence can improve disease outcome.
authors.affiliation: Department of Rheumatology, Erasmus MC, University Medical Center Rotterdam, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands. a.pasma@erasmusmc.nl.|Department of Psychiatry, section Medical Psychology and Psychotherapy, Erasmus MC, University Medical Center Rotterdam, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands. a.pasma@erasmusmc.nl.
authors.forename: Annelieke
authors.initials: A
authors.lastname: Pasma
authors.affiliation: Department of Rheumatology, Erasmus MC, University Medical Center Rotterdam, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands. 327956cs@student.eur.nl.
authors.forename: Charlotte V
authors.initials: CV
authors.lastname: Schenk
authors.affiliation: Department of Psychiatry, section Medical Psychology and Psychotherapy, Erasmus MC, University Medical Center Rotterdam, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands. r.timman@erasmusmc.nl.
authors.forename: Reinier
authors.initials: R
authors.lastname: Timman
authors.affiliation: Department of Psychiatry, section Medical Psychology and Psychotherapy, Erasmus MC, University Medical Center Rotterdam, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands. j.vanbusschbach@erasmusmc.nl.
authors.forename: Jan J V
authors.initials: JJ
authors.lastname: Busschbach
authors.affiliation: Department of Pharmacy, Sint Maartenskliniek, Hengstdal 3, 6574, NA, Nijmegen, The Netherlands. b.vandenbemt@maartenskliniek.nl.
authors.forename: Bart J F
authors.initials: BJ
authors.lastname: van den Bemt
authors.affiliation: Department of Rheumatology, Groene Hart Hospital, Bleulandweg 10, 2803 HH, Gouda, The Netherlands. esmeralda.molenaar@ghz.nl.
authors.forename: Esmeralda
authors.initials: E
authors.lastname: Molenaar
authors.affiliation: Department of Rheumatology, Sint Maartenskliniek, Hengstdal 3, 6574 NA, Nijmegen, The Netherlands. w.noort-vanderlaan@maartenskliniek.nl.
authors.forename: Willemijn H
authors.initials: WH
authors.lastname: van der Laan
authors.affiliation: Department of Rheumatology, Sint Franciscus Gasthuis, Kleiweg 500, 3045, PM, Rotterdam, The Netherlands. s.schrauwen@sfg.nl.
authors.forename: Saskia
authors.initials: S
authors.lastname: Schrauwen
authors.affiliation: Department of Psychiatry, section Medical Psychology and Psychotherapy, Erasmus MC, University Medical Center Rotterdam, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands. a.vantspijker@erasmusmc.nl.
authors.forename: Adriaan
authors.initials: A
authors.lastname: Van't Spijker
authors.affiliation: Department of Rheumatology, Erasmus MC, University Medical Center Rotterdam, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands. j.hazes@erasmusmc.nl.
authors.forename: Johanna M W
authors.initials: JM
authors.lastname: Hazes
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000473:pathology*; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged
chemical_list: D018501:Antirheumatic Agents