EFFECTIVENESS OF MEDICATION USE AND DETERMINANTS OF IRREGULAR ADHERENCE AMONG PATIENTS WITH RHEUMATOID ARTHRITIS

Abstract

Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease requiring long-term pharmacological management to prevent joint destruction and disability. This study evaluates the efficacy of methotrexate (MTX) therapy and examines the prevalence, predictors, and reasons for medication non-adherence among RA patients during the first six months of treatment. Data were analyzed from a prospective multicenter cohort of 606 incident MTX users. Disease activity was assessed using DAS28 scores, and adherence was monitored weekly over 26 weeks. Overall, 26% of patients reported at least one episode of non-adherence, with the majority classified as intentional (71%). The mean number of non-adherent weeks was 2.5. Higher baseline disease activity, increased fatigue, multiple comorbidities, and stronger medication concerns relative to perceived necessity were significant predictors of non-adherence. Patients with greater symptom burden were paradoxically more likely to deviate from prescribed therapy. Non-adherence was associated with suboptimal disease control and increased risk of treatment discontinuation. These findings highlight that while MTX demonstrates substantial clinical efficacy when taken consistently, psychological and clinical factors significantly influence adherence behavior. Targeted, patient-centered interventions addressing medication beliefs and comorbidity burden may improve long-term therapeutic outcomes in RA management.