title: Adherence to Methotrexate therapy in Rheumatoid Arthritis.
abstract: OBJECTIVE
  To determine adherence to methotrexate (MTX) therapy in patients with Rheumatoid Arthritis (RA) and to identify factors that promote either adherence or non adherence.
  
  
  METHODS
  One hundred Rheumatoid Arthritis patients on MTX for at least two months were enrolled. Questionnaire was completed by direct interview. Details recorded were, demographics (age, sex, education, monthly income), disease duration, duration on MTX and current dose. Disease Activity Score on 28 joint counts (DAS 28) at the current visit, concomitant drugs taken and number of doses of MTX missed in the previous 8 weeks were noted. Non adherence was defined as omission of any three or more prescribed doses of MTX in previous 8 week. Patients were asked for the factors that motivated their adherence to MTX as well as factors for non adherence. Presence of side effects due to MTX was also recorded.
  
  
  RESULTS
  Non adherence was found among 23% of cases. Patients of low socioeconomic group (p <0.0001) and on MTX for longer duration (p <0.001) had higher non adherence. Non adherent patients had significantly higher disease activity as measured by DAS 28 (p<0.001). Good counseling and education by the doctor was a strong predictor of adherence (p <0.001). Lack of affordability (p <0.001); lack of availability at local pharmacy (p <0.001); lack of family support (p <0.001) and lack of awareness regarding need and importance of MTX (p < 0.001were found as significant factors for non adherence.
  
  
  CONCLUSIONS
  MTX non adherence in RA is noted in about one fourth of study group. Various economical and social issues lead to non adherence but good patient education and counseling by doctor could promote adherence in this study group.
authors.affiliation: Dr. Nasim Arshad, FCPS. Division of Rheumatology, Fatima Memorial Hospital, Shadman. Lahore, Pakistan.
authors.forename: Nasim
authors.initials: N
authors.lastname: Arshad
authors.affiliation: Prof, Nighat Mir Ahmad, MD, DABIM, DABR. Division of Rheumatology, Fatima Memorial Hospital, Shadman. Lahore, Pakistan.
authors.forename: Nighat Mir
authors.initials: NM
authors.lastname: Ahmad
authors.affiliation: Dr. Mohammad Ahmed Saeed, FCPS. Division of Rheumatology, Fatima Memorial Hospital, Shadman. Lahore, Pakistan.
authors.forename: Muhammad Ahmed
authors.initials: MA
authors.lastname: Saeed
authors.affiliation: Dr. Saira Khan, MRCP. Division of Rheumatology, Fatima Memorial Hospital, Shadman. Lahore, Pakistan.
authors.forename: Saira
authors.initials: S
authors.lastname: Khan
authors.affiliation: Dr. Shabnam Batool, FCPS. Division of Rheumatology, Fatima Memorial Hospital, Shadman. Lahore, Pakistan.
authors.forename: Shabnam
authors.initials: S
authors.lastname: Batool
authors.affiliation: Dr., Sumaira Farman, FRCP. Division of Rheumatology, Fatima Memorial Hospital, Shadman. Lahore, Pakistan.
authors.forename: Sumaira
authors.initials: S
authors.lastname: Farman
keywords: Adherence; Methotrexate; Rheumatoid arthritis