Medication adherence has an impact on disease activity in rheumatoid arthritis: a systematic review and meta-analysis

Abstract

ObjectiveDisease activity of rheumatoid arthritis (RA) patients was often measured by the 28-joint count disease activity score (DAS-28), which consists of 28 swollen and tender joint counts, patient’s assessment of disease activity (visual analog scale [VAS]) and erythrocyte sedimentation rate. C-reactive protein was also used to measure disease activity in RA patients. The aim was to explore the impact of medication adherence on disease activity in patients with RA.MethodsA systematic search was performed in major electronic databases (PubMed, Web of Science, the Cochrane Library, CNKI, VIP and Wan fang) to identify studies reporting medication adherence and disease activity in RA patients. Results were expressed as mean difference (MD) and 95% CI.ResultsA total of seven identified studies matched the inclusion criteria, reporting on a total of 1,963 adult RA patients in the analysis. The total score of DAS-28 was significantly lower in adherent patients than in nonadherent subjects (MD =−0.42, 95% CI [−0.80, −0.03], P=0.03). Similarly, a significant difference was observed between medication adherent and nonadherent groups in erythrocyte sedimentation rate (MD =−7.39, 95% CI [−11.69, −3.08], P<0.01) and tender joint count (MD =−1.29, 95% CI [−2.51, −0.06], P=0.04). Interestingly, the results of the meta-analysis showed no significant difference between medication adherent and nonadherent patients in swollen joint count (MD =−0.16, 95% CI [−2.13, 1.80], P=0.87), visual analog scale (MD =1.41, 95% CI [−3.68, 6.50], P=0.59) and C-reactive protein (MD =0.35, 95% CI [−0.64, 1.34], P=0.49).ConclusionThe study suggests that RA patients with higher medication adherence tended to have lower disease activity.

Mobile Phone Text Messages and Effect on Treatment Adherence in Patients Taking Methotrexate for Rheumatoid Arthritis: A Randomized Pilot Study

“…Given the cross‐sectional nature of our evaluation of adherence at baseline, a causal relationship is difficult to prove. However, one could make the case that poor adherence might be responsible for higher levels of disease activity .…”

“…However, we observed a correlation between the change in the CQR‐19 score and the change in HAQ score in the TM group, suggesting a modest clinical impact. In view of the well‐documented link between adherence and the effectiveness of MTX, the anticipated clinical impact would lead to a decrease in the DAS28 and, potentially, in cardiovascular mortality . Last, overall patient satisfaction was high, and even higher in patients with an additional intervention (the PC and TM groups).…”

“…A recent meta‐analysis showed that nonadherence in RA is responsible for a mean increase of 0.48 in the Disease Activity Score in 28 joints (DAS28), and a mean increase of 1.29 in the number of painful joints . In addition to the loss of opportunity for the patient to improve, poor adherence has a health economic impact on society via a combination of direct costs (related to waste) and indirect costs (related to poor disease control) .…”

Patient and Caregiver Priorities for Medication Adherence in Gout, Osteoporosis, and Rheumatoid Arthritis: Nominal Group Technique

“…Approximately 50% of women with OP discontinue prescribed treatment in 1 year (14). Nonadherence is associated with increased disease activity, long‐term joint damage in gout and RA, and increased fractures in OP (12,15–19).

Trust in the doctor and doctor’s knowledge, medication effectiveness and side effects, and patients’ medication‐taking routine and knowledge were factors important to patients and caregivers for medication adherence. Strengthening doctor–patient trust, balancing medication benefits and harms, and empowering patients with medication knowledge and skills to form effective routines are potential solutions for medication nonadherence that require further investigation.

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Effect of medication adherence on disease activity among Japanese patients with rheumatoid arthritis

“…Several studies have demonstrated an association between higher medication adherence and better clinical response to therapies in RA patients [ 8 – 13 ]. Of these investigations, one has indicated that medication adherence is associated with improvements in disease activity and physical functional outcomes among DMARDs-naïve patients, but not among existing users [ 13 ].…”