Adherence to Treatment in Patients with Rheumatoid Arthritis from Spain

Figures & data

Box 1 Compliance Questionnaire in Rheumatology

Instructions to the Patient
On the next pages you will find a number of statements made by patients with a rheumatic disease. Please indicate for each statement how far you agree, by placing a circle around the number that reflects your opinion best.
1. If the rheumatologist tells me to take medicines, I do so.
2. I take my anti-rheumatic* medicines because I then have fewer problems.
3. I definitely do not dare to miss my anti-rheumatic medications.
4. If I can help myself with alternative therapies, I prefer that to what my rheumatologist prescribes**.
5. My medicines are always stored in the same place, and that’s why I do not forget them.
6. I take my medicines because I have complete confidence in my rheumatologist.
7. The most important reason to take my anti-rheumatic medicines is that I can still do what I want to do.
8. I do not like to take medicines. If I can do without them, I will**.
9. When I am on vacation, it sometimes happens that I do not take my medicines**.
10. I take my anti-rheumatic drugs, for otherwise what’s the point of consulting a rheumatologist?
11. I do not expect miracles from my anti-rheumatic medicines**.
12. If you cannot stand the medicines you might say: “throw it away, no matter what”**.
13. If I do not take my anti-rheumatic medicines regularly, the inflammation returns.
14. If I do not take my anti-rheumatic medicines, my body warns me.
15. My health goes above everything else and if I have to take medicines to keep well, I will.
16. I use a dose organizer for my medications.
17. What the doctor tells me, I hang on to.
18. If I do not take my anti-rheumatic medicines, I have more complaints.
19. It happens every now and then, I go out for the weekend and then I do not take my medicines**. The answers are scored on a 4-point Likert scale with anchors: 1. do not agree at all; 2. do not agree; 3. agree; 4. agree very much. *For gout patients, the word anti-rheumatic was changed to anti-gout. **These items were recoded to compute a total score.

Table 1 Baseline Characteristics of Patients

	n = 859
Age (mean ± SD)	60.2 ± 12.6
Female sex, n (%)	668 (77.8)
Duration of RA in year, median (IQR)	8.7 (3-9-15.7)
Level of education, n (%) n = 743
No studies	51 (6.8)
Primary education	349 (46.9)
Secondary education	209 (28.1)
Superior education	132 (17.8)
Other	2 (0.3)
Civil status, n (%) n = 754
Single Married	86 (11.4) 549 (72.8)
Divorced	53 (7)
Widow	66 (8.8)
Cohabitation, n (%) n = 754	658 (87.3)
Number of drugs, n (%)
1	294 (34.2)
2	356 (41.4)
3	140 (16.3)
4	44 (5.1)
≥5	25 (2.9)
Glucocorticoids, n (%)	367 (57.3)
cDMARDs, n (%)	682 (79.3)
bDMARDs n (%)	418 (48.7)

Abbreviations: bDMARDS, biologic disease-modifying antirheumatic drugs; cDMARDs, conventional disease-modifying antirheumatic drugs; IQR, interquartile range; RA, rheumatoid arthritis; SD, standard deviation.

Table 2 Association of Study Variables with Treatment Adherence

Variables	Univariate Analysis	Coef. (95% CI)	Multivariate Analysis	Coef. (95% CI)	Multivariate Analysis Adjusted for Age and Sex	Coef. (95% CI)
Duration of RA	0.412	0.013 (−0.02, 0.04)	0.839	0.004 (−0.03, 0.03)	–	–
Number of drugs	0.023	0.31 (0.04, 0.57)	0.008	0.47 (0.12, 0.81)	0.012	0.34 (0.07, 0.61)
Glucocorticoids use	0.282	0.33 (−0.27, 0.93)	0.756	−0.11 (−0.82, 0.60)	–	–
cDMARD use	0.314	−0.37 (−1.11, 0.36)	0.131	−0.72 (−1.65, 0.21)	–	–
SC cDMARD vs oral	0.275	−0.40 (−1.13, 0.32)	0.544	−0.24 (−0.10, 0.53)	–	–
bDMARD use	0.750	0.11 (−0.48, 0.71)	0.295	−0.42 (−1.23, 0.37)	–	–
IV bDMARD vs SC	0.597	0.22 (−0.60, 0.11)	0.533	0.31 (−0.66, 1.28)	–	–
Civil status	0.062	−0.28 (−0.58, 0.01)	0.571	−0.12 (−0.55, 0.31)	–	–
Cohabitation	0.046	−0.41 (−0.82, −0.01)	0.348	−0.32 (−0.10, 0.34)	0.023	−0.47 (−0.88, −0.07)
Education level	0.387	−0.10 (−0.31, 0.12)	0.765	0.04 (−0.24, 0.33)	–	–
Sex	0.357	0.34 (−0.38, 1.05)	0.406	0.31 (−0.42, 1.04)	0.359	0.33 (−0.38, 1.05)
Age	0.967	0.01 (−0.02, 0.02)	0.744	0.004 (−0.02, 0.03)	0.815	0.003 (−0.02, 0.03)
Specific day hospital vs polyvalent	0.299	0.20 (−0.18, 0.59)	0.203	0.26 (−0.14, 0.67)	–	–

Abbreviations: bDMARDS, biologic disease-modifying antirheumatic drugs; cDMARDs, conventional disease-modifying antirheumatic drugs; Coef, regression coefficient; IV, intravenous; RA, rheumatoid arthritis; SC, subcutaneous.