Medication Adherence of Patients with Systemic Lupus Erythematosus and Rheumatoid Arthritis Considering the Psychosocial Factors, Health Literacy and Current Life Concerns of Patients

Abstract

Background: In systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA), due to their long term, multi-drug exposure and their side effects, non-adherence to therapy is common and is associated with adverse clinical outcome. In this study, we aimed to evaluate and compare medication adherence in patients with SLE and RA considering their psychosocial factors, health literacy, and current life concerns. Methods: 88 patients fulfilled the criteria of RA(N:46) and SLE(N:42);using disease-modifying antirheumatic drugs or immunosuppressive, we evaluated, their demographic data, co-morbid diseases, the number of medications, estimated income, having health insurance, family size and disease poor prognostic factors. The 8-item Morisky’s Medication Adherence, Depression by Beck depression inventory (21 Q), and drug literacy level were used. Results: Medication non-adherence was seen in 91.3% of the RA group and 90.4% of the SLE group. Moderate to very severe depression was seen in [21 (45.7%)] and [12 (25.9%)] of the RA and SLE patients, respectively. In the SLE group, depression and having poor prognostic factors, and in the RA group, depression, having co-morbid diseases and higher pill numbershad a significant effect on medication adherence. Conclusion: There was a high prevalence of drug non-adherence in our RA and SLE patients. The most prevalent factor in non-adherence in both groups was depression. After that, in RA patients the presence of co-morbid disease and in SLE patients the presence of poor prognostic factors were related to non-adherence. Factors like income, health insurance, disease duration, and health literacy had no significant effect on medication adherence.

Persistence of Depression and Anxiety despite Short-Term Disease Activity Improvement in Patients with Systemic Lupus Erythematosus: A Single-Centre, Prospective Study

“…Using the validated MMAS-4 instrument, we found that 47.5% of patients with active lupus had low or very low compliance to treatment, a percentage that falls within the range (typically, 43–75%) of previously reported adherence rates [ 62 ]. Notably, increased levels of mental disorders tended to correlate with non-adherence, an association that has been previously shown especially for depression in several observational studies [ 25 , 26 , 27 , 28 , 63 , 64 ]. In this regard, anxiety and depression have been recognized as major determinants of the resilience [ 29 ] and illness perception [ 16 ] of lupus patients, which can both impact on compliance.…”

Health disparities in systemic lupus erythematosus—a narrative review

“…A study of patients with SLE and RA out of Iran showed an association between depression and medication non-adherence in both groups [ 74 ]. Medication adherence was studied in a group of Black and White patients with lupus and amongst Black patients depression was a factor in both medication non-adherence and missed appointments [ 75 ].…”

“…Katz et al found that patients with SLE and limited health literacy gave worse patient-reported outcome scores [ 81 ]. Interestingly, there were several studies which failed to show an association between medication non-adherence and health literacy [ 68 , 73 , 74 ]…”

Adherence to Treatment and Psycho-Emotional Status in Patients With Psoriatic Arthritis and Comorbidity

“…Для оцінки коморбідності використовували кумулятивний індекс захворювань CIRS (Cumulative Illness Rating Score) [12]. При скринінгу психічних розладів (тривога та депресія) застосовували Госпітальну шкалу тривоги та депресії HADS (Hospital Anxiety and Depression Scale) [13]. Оцінку прихильності до лікування проводили за допомогою шкали Моріскі-Гріна.…”