title: Psychosocial predictors of DMARD adherence in the first three months of treatment for early arthritis.
abstract: To induce disease remission, early arthritis patients should adhere to their disease-modifying antirheumatic drugs (DMARD) in the first months after diagnosis. It remains unknown why some patients are non-adherent. We aimed to identify patients at risk for non-adherence in the first 3 months of treatment.
  
  
  
  Adult DMARD-naive early arthritis patients starting synthetic DMARDs filled out items on potential adherence predictors at baseline. Adherence was measured continuously. Non-adherence was defined as not opening the electronically monitored pill bottle when it should have been. Items were reduced and clustered using principal component analysis. The most discriminating items were identified with latent trait models. We used a multivariable logistic regression model to find non-adherence predictors.
  
  
  
  301 patients agreed to participate. Adherence was high and declined over time. Principal component analysis led to 7 dimensions, while subsequent latent trait models analyses led to 15 dimensions. Two dimensions were associated with adherence, one dimension was associated with non-adherence.
  
  
  
  Information seeking behavior and positive expectations about the course of the disease are associated with adherence. Patients who become passive because of pain are at risk for non-adherence.
  
  
  
  Rheumatologists have cues to identify non-adherence, and may intervene on non-adherence through implementing shared decision making techniques.
authors: Department of Rheumatology, Erasmus MC, University Medical Center Rotterdam, the Netherlands; Department of Psychiatry, section Medical Psychology and Psychotherapy, Erasmus MC, University Medical Center Rotterdam, the Netherlands. Electronic address: a.pasma@erasmusmc.nl.
authors: Annelieke
authors: A
authors: Pasma
authors: Department of Rheumatology, Erasmus MC, University Medical Center Rotterdam, the Netherlands.
authors: Johanna M W
authors: JM
authors: Hazes
authors: Department of Psychiatry, section Medical Psychology and Psychotherapy, Erasmus MC, University Medical Center Rotterdam, the Netherlands.
authors: Jan J V
authors: JJ
authors: Busschbach
authors: Department of Rheumatology, Sint Maartenskliniek, Nijmegen, the Netherlands.
authors: Willemijn H
authors: WH
authors: van der Laan
authors: Department of Rheumatology, Amphia hospital, Breda, the Netherlands.
authors: Cathelijne
authors: C
authors: Appels
authors: Department of Rheumatology, Sint Antonius hospital, Nieuwegein, the Netherlands.
authors: Yaël A
authors: YA
authors: de Man
authors: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, the Netherlands.
authors: Daan
authors: D
authors: Nieboer
authors: Department of Psychiatry, section Medical Psychology and Psychotherapy, Erasmus MC, University Medical Center Rotterdam, the Netherlands.
authors: Reinier
authors: R
authors: Timman
authors: Department of Psychiatry, section Medical Psychology and Psychotherapy, Erasmus MC, University Medical Center Rotterdam, the Netherlands.
authors: Adriaan
authors: A
authors: van 't Spijker
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000523:psychology; D001294:Attitude to Health; D005260:Female; D006801:Humans; D057226:Information Seeking Behavior; D007389:Internal-External Control; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D009042:Motivation; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016903:Drug Monitoring
chemical_list: D018501:Antirheumatic Agents
keywords: Adherence; DMARDs; Early arthritis; Psychosocial factors