Medication adherence in patients with juvenile idiopathic arthritis

Adriano, Liana Silveira; Fonteles, Marta Maria de França; Azevedo, Maria de Fátima Menezes; Beserra, Milena Pontes Portela; Romero, Nirla Rodrigues

doi:10.1016/j.rbre.2016.05.004

Cited by 8 publications

(18 citation statements)

References 15 publications

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“…Quanto a possíveis relações do perfil epidemiológico e social dos participantes com a adesão, faixa etária da criança, renda e escolaridade do cuidador não demonstraram associação com a adesão ao fármaco, semelhante ao encontrado em acompanhamento de pacientes pediátricos com condição crônica de saúde e em uso contínuo de medicamentos em outro estudo (Adriano et al, 2017). A forma farmacêutica também não interferiu nas taxas de adesão ao ácido fólico.…”

Section: Resultsunclassified

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Adesão ao uso do ácido fólico em crianças com doença falciforme diagnosticadas na triagem neonatal: fatores associados.

Soares

Mazzafera

Amorim

et al. 2022

RSD

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Introdução: O ácido fólico é utilizado como terapia profilática na anemia hemolítica, e sua baixa adesão em crianças com doença falciforme contribui para o surgimento de complicações e piora do estado de saúde e, consequentemente, aumento dos custos assistenciais. Objetivo: Analisar a adesão à farmacoterapia com ácido fólico em crianças com hemoglobinopatia SS (HbSS) ou SC (HbSC), diagnosticadas na triagem neonatal. Método: Estudo transversal, com dosagens de níveis séricos de folato e aplicação dos Teste de Morisky-Green (TMG) e Brief Medication Questionnaire (BMQ) aos cuidadores. Resultados: Verificaram-se 34,0% e 40,4% de “aderentes”, respectivamente, para TMG e BMQ. Constatou-se folato sérico elevado em 78,7% dos participantes, e nenhum deles apresentou deficiência. Forma farmacêutica (p=0,719), faixa etária (p=0,875), renda (p=0,944) e escolaridade do cuidador (p=0,070) não foram fatores associados à adesão. Pacientes HbSS registram mais que o quádruplo da adesão dos HbSC (48,3% vs. 11,1%; p=0,012). Dificuldade de acesso ao medicamento e interrupção/atraso no tratamento foram os maiores contribuintes à não adesão. Conclusões: Observou-se contraste entre a adesão referida pelos questionários e os níveis séricos elevados de ácido fólico e a necessidade de melhoria do acesso ao medicamento.

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Section: Resultsunclassified

“…A forma farmacêutica também não interferiu nas taxas de adesão ao ácido fólico. Esta observação sugere que a aderência seja mais específica do paciente do que específica do fármaco, tal como apontam trabalhos anteriores (Patel et al, 2010;Bugni et al, 2012;Adriano et al, 2017;). Contudo, um achado deste trabalho foi relevante:…”

Section: Resultsunclassified

Adesão ao uso do ácido fólico em crianças com doença falciforme diagnosticadas na triagem neonatal: fatores associados.

Soares

Mazzafera

Amorim

et al. 2022

RSD

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“…In addition, to achieve optimal health outcomes, children and young people need to adhere to their prescribed treatment plan [ 21 , 22 ], and parents need to support treatment recommendations [ 2 , 22 ]. However, suboptimal rates of adherence are commonly reported [ 22 - 24 ].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of eHealth and mHealth Interventions Supporting Children and Young People Living With Juvenile Idiopathic Arthritis: Systematic Review and Meta-analysis

Butler¹,

Sculley²,

Santos³

et al. 2022

J Med Internet Res

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Background Juvenile idiopathic arthritis (JIA) management aims to promote remission through timely, individualized, well-coordinated interdisciplinary care using a range of pharmacological, physical, psychological, and educational interventions. However, achieving this goal is workforce-intensive. Harnessing the burgeoning eHealth and mobile health (mHealth) interventions could be a resource-efficient way of supplementing JIA management. Objective This systematic review aims to identify the eHealth and mHealth interventions that have been proven to be effective in supporting health outcomes for children and young people (aged 1-18 years) living with JIA. Methods We systematically searched 15 databases (2018-2021). Studies were eligible if they considered children and young people (aged 1-18 years) diagnosed with JIA, an eHealth or mHealth intervention, any comparator, and health outcomes related to the used interventions. Independently, 2 reviewers screened the studies for inclusion and appraised the study quality using the Downs and Black (modified) checklist. Study outcomes were summarized using a narrative, descriptive method and, where possible, combined for a meta-analysis using a random-effects model. Results Of the 301 studies identified in the search strategy, 15 (5%) fair-to-good–quality studies met the inclusion criteria, which identified 10 interventions for JIA (age 4-18.6 years). Of these 10 interventions, 5 (50%) supported symptom monitoring by capturing real-time data using health applications, electronic diaries, or web-based portals to monitor pain or health-related quality of life (HRQoL). Within individual studies, a preference was demonstrated for real-time pain monitoring over recall pain assessments because of a peak-end effect, improved time efficiency (P=.002), and meeting children’s and young people’s HRQoL needs (P<.001) during pediatric rheumatology consultations. Furthermore, 20% (2/10) of interventions supported physical activity promotion using a web-based program or a wearable activity tracker. The web-based program exhibited a moderate effect, which increased endurance time, physical activity levels, and moderate to vigorous physical activity (standardized mean difference [SMD] 0.60, SD 0.02-1.18; I2=79%; P=.04). The final 30% (3/10) of interventions supported self-management development through web-based programs, or apps, facilitating a small effect, reducing pain intensity (SMD −0.14, 95% CI −0.43 to 0.15; I2=53%; P=.33), and increasing disease knowledge and self-efficacy (SMD 0.30, 95% CI 0.03-0.56; I2=74%; P=.03). These results were not statistically significant. No effect was seen regarding pain interference, HRQoL, anxiety, depression, pain coping, disease activity, functional ability, or treatment adherence. Conclusions Evidence that supports the inclusion of eHealth and mHealth interventions in JIA management is increasing. However, this evidence needs to be considered cautiously because of the small sample size, wide CIs, and moderate to high statistical heterogeneity. More rigorous research is needed on the longitudinal effects of real-time monitoring, web-based pediatric rheumatologist–children and young people interactions, the comparison among different self-management programs, and the use of wearable technologies as an objective measurement for monitoring physical activity before any recommendations that inform current practice can be given.

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“…J uvenile idiopathic arthritis (JIA) is a heterogeneous group of conditions which encompasses all forms of arthritis of unknown aetiology lasting for at least 6 weeks and with onset before the age of 16 years (1) . JIA is a diagnosis of exclusion, and remains the most common childhood rheumatic disease.…”

Section: Introductionmentioning

confidence: 99%

Fibrosis indexes in adolescents with juvenile idiopathic arthritis treated with methotrexate

Parkhomenko¹,

Strashok²,

Pavlov³

et al. 2021

Pediatr Med Rodz

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Juvenile idiopathic arthritis is the most common form of arthritis in children and adolescents. Methotrexate is the mainstay of juvenile idiopathic arthritis treatment. Methotrexate is well known to cause serum aminotransferase elevations, and longterm therapy has been linked to the development of fatty liver disease, fibrosis and even cirrhosis. The aim of the study was to assess non-invasive liver fibrosis indexes in adolescents with juvenile idiopathic arthritis treated with methotrexate. Materials and methods: A total of 68 children with juvenile idiopathic arthritis were enrolled in the study. A total of 68 children – 25 boys (36.8%) and 43 girls (63.2%) – were examined. The children were divided into four groups based on the methotrexate cumulative dose. The following data were analysed: total bilirubin and its fractions, cholesterol, β-lipoproteins, aspartate transaminase, alanine aminotransferase. Fibrosis indexes, i.e. APRI, FIB-4 score, AAR, AARPRI, were studied. Results: When studying the dynamics of non-invasive indices, their heterogeneous nature and cumulative dose dependence are determined. Statistically significant changes in fibrosis indexes and biochemical parameters were observed when the children reached cumulative methotrexate doses of 1 g and 3 g. Conclusions: It is possible to monitor carefully liver condition during the whole treatment and conduct a more in-depth examination only if it is necessary. Our data shows that the APRI index (AST to platelet ratio index) is most indicative.

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Medication adherence in patients with juvenile idiopathic arthritis

Abstract: Our findings showed problems in the adherence process related to inattention, forgetfulness and irregularity in getting medicines, reinforcing the need for the development of strategies to facilitate a better understanding of treatment and to ensure adherence.

Cited by 8 publications

References 15 publications

Adesão ao uso do ácido fólico em crianças com doença falciforme diagnosticadas na triagem neonatal: fatores associados.

Adesão ao uso do ácido fólico em crianças com doença falciforme diagnosticadas na triagem neonatal: fatores associados.

Effectiveness of eHealth and mHealth Interventions Supporting Children and Young People Living With Juvenile Idiopathic Arthritis: Systematic Review and Meta-analysis

Fibrosis indexes in adolescents with juvenile idiopathic arthritis treated with methotrexate

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