Adherence
Medication Adherence of Patients with Selected Rheumatic Conditions: A Systematic Review of the Literature

https://doi.org/10.1016/j.semarthrit.2008.01.011Get rights and content

Objective

Nonadherence with medication treatment has been found to occur in large proportions of patients with a broad range of chronic conditions. Our aim was to perform a systematic review of the literature examining adherence with treatments for inflammatory rheumatic conditions to assess the magnitude of the problem in this patient population.

Methods

A MEDLINE search of English language literature was performed to identify studies published between January 1, 1985 and November 30, 2007 that evaluated adherence with chronic medications needed in the treatment of rheumatic conditions.

Results

A total of 20 articles met the criteria for evaluation, the majority of which focused on the treatment of rheumatoid arthritis. Most of the studies examined the use of nonsteroidal anti-inflammatory medications and disease-modifying antirheumatic drugs. Adherence was assessed based on self-report, pill counts, pharmacy dispensings, openings of pill containers using electronic devices, laboratory assays, and physician assessment. Adherence varied greatly based on the adherence measure used, arthritic condition evaluated, and medication under study. Overall, the highest rates of adherence were based on self-reports for a wide variety of medications and conditions (range of persons reporting adherence was 30 to 99%), while the lowest adherence rates were for allopurinol based on pharmacy dispensings (18-26%).

Conclusions

Adherence has not been widely examined for most chronic inflammatory rheumatic conditions and the few studies that exist used different definitions and populations, thus limiting any conclusions. However, the current literature does suggest that nonadherence is a substantial problem.

Section snippets

Identification and Selection of Articles

A MEDLINE search of English language literature was performed to identify studies published between January 1, 1985 and November 30, 2007 that evaluated adherence, compliance, or persistence of medications for the treatment of rheumatic conditions. The following key words were used as search terms: (patient compliance or adherence or persistence or discontinuation or switching) and (ankylosing spondylitis, or arthritis, or gout, or psoriatic arthritis, or polymyalgia rheumatica, or rheumatoid

Characteristics of the Studies

The majority of studies focused on the treatment of rheumatoid arthritis (Table 1). There were 4 or fewer studies examining adherence in conditions including juvenile idiopathic arthritis (14, 24), polymyalgia rheumatica (25), systemic lupus erythematosus (26, 27, 28, 29), and gout (7, 25, 30). The most common medications studied were nonsteroidal anti-inflammatory drugs (NSAIDs) and disease-modifying antirheumatic agents (DMARDs). These studies employed a variety of study designs to assess

Discussion

This systematic review of the literature is the first to examine the current state of knowledge regarding the use of medications for the treatment of selected chronic inflammatory rheumatic conditions. Overall there were 20 studies that fulfilled criteria to be included in the review, the majority of which were focused on the treatment of rheumatoid arthritis. Many of the studies focused on treatments that are not commonly used today, including D-penicillamine and chronic high-dose salicylates.

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  • Cited by (0)

    Drs. Harrold and Andrade are investigators in the HMO Research Network Center for Education and Research on Therapeutics (Agency for Healthcare Research and Quality HS10391). Dr. Harrold was supported by Grant Number K23AR053856 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Arthritis and Musculoskeletal and Skin Diseases or the National Institutes of Health.

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