Adherence to Methotrexate in Iraqi Patients With Rheumatoid Arthritis : A Cross-Sectional Study

Abstract

Introduction: Methotrexate (MTX) is the most widely used disease modifying anti-rheumatic drugs (DMARDs) in the treatment of rheumatoid arthritis (RA). In RA, medication adherence is variable and sub-optimal. Poor adherence affects 20-70% of patients. Adherence to MTX is the key to attaining the goal of low disease activity or disease remission. The aim of the study is to determine adherence of RA patients to MTX when used as a monotherapy and when combined with anti-tumor necrosis factor (TNF) and to look for the factors that may positively and negatively affect adherence. Methods: An observational cross sectional study was conducted at Rheumatology Clinic/Baghdad Teaching Hospital over a period from January-June 2020. A total of 100 patients diagnosed with RA according to American College of Rheumatology (ACR) and European League against Rheumatism (EULAR), 2010 criteria are included. All were on MTX for more than 3 months. A questionnaire was used to collect information from them. Results: Young age, middle-high educational level and good socio-economic state increase the regular MTX intake and thus improve the adherence. Long duration of the disease and treatment, oral and combination therapy decrease the patients’ adherence. Conclusion: Non-adherence to MTX is noted frequently in RA patients and variable factors tend to affect adherence. Multiple factors encourage or discourage the continuity of MTX intake, some are related to patients themselves while others are related to the course of the disease or MTX itself.