Poor Adherence to Medication in Adults with Rheumatoid Arthritis: Reasons and Solutions

This review examines evidence on the prevalence of non-adherence to medication in adults with rheumatoid arthritis, the reasons for non-adherence, and the effectiveness of interventions to improve adherence. Medications for rheumatoid arthritis (NSAIDs, corticosteroids, disease-modifiers, and biologic agents) are not curative, but can reduce symptoms and slow progression of the disease. Evidence consistently suggests that adherence to medications for rheumatoid arthritis is low in adults, and is often <50%. These drugs can be associated with serious adverse effects. Evidence suggests that non-adherence in rheumatoid arthritis cannot be explained by gender or age. Other patient characteristics, such as educational level and socioeconomic status, may create literacy and financial barriers to adherence. The strongest associations are reported between adherence and views about rheumatoid arthritis as a disease; beliefs that disease-modifying antirheumatic drugs do not work and have too many adverse effects; unrealistic or uninformed patient expectations of risk; lack of self-efficacy; lack of social support; cost of prescription medications, and poor patient-provider relationships. There have been few interventions designed specifically to improve medication adherence in patients with rheumatoid arthritis. Most interventions have been based on patient education and the teaching of self-management techniques. Educational interventions have had limited effectiveness in changing behavior because of the limited ability of changes in knowledge to produce lasting behavioral change. The effect of group therapy and cognitive-behavioral therapy on medicine adherence is not clear. Those interventions that are effective tend to emphasize developing a daily routine of self-management activities, coping strategies, self-efficacy, and problem-solving. Future work is required to develop evidence-based, pragmatic, patient-centered interventions to improve medication adherence in patients with rheumatoid arthritis. Practitioners require support and training in the communication of risk and incorporation of patients' beliefs into the consultation process. Policy makers need to reduce barriers to access, such as the costs of drugs.