Disease control and its associated factors in outpatients with rheumatoid arthritis
More details
Hide details
Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, JORDAN
College of Pharmacy, Al Ain University, Abu Dhabi, UNITED ARAB EMIRATES
Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, JORDAN
Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah, Sharjah, UNITED ARAB EMIRATES
Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, JORDAN
Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UNITED ARAB EMIRATES
Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman, JORDAN
Online publication date: 2023-08-01
Publication date: 2023-11-01
Electron J Gen Med 2023;20(6):em532
The present study aimed to evaluate disease activity and explore the factors associated with poor disease control among patients with rheumatoid arthritis (RA). This cross-sectional study was conducted at outpatient rheumatology clinics in two teaching hospitals in Jordan. Medication adherence was assessed using the validated five-item compliance questionnaire for rheumatology, and disease activity was assessed using the clinical disease activity Index score. Ordinal regression was performed to explore the factors associated with uncontrolled RA. Most of the participants (n=261) demonstrated moderate to high disease activity (71.2%). Seronegative RA (B=-0.882, CI [-1.584/-0.180], p<0.05) was significantly associated with lower disease activity, while medication non-adherence was significantly associated with poor RA control (B=1.023, CI [0.289-1.756], p<0.01). Future research should explore the factors associated with medication non-adherence. These factors should be targeted in future interventions to improve RA control, particularly in patients who suffer from high disease severity.
Smolen JS, Aletaha D, McInnes IB. Rheumatoid arthritis. Lancet. 2016;388(10055):2023-38. https://doi.org/10.1016/S0140-... PMid:27156434.
van Gestel AM, Haagsma CJ, van Riel PL. Validation of rheumatoid arthritis improvement criteria that include simplified joint counts. Arthritis Rheum. 1998;41(10):1845-50. https://doi.org/10.1002/1529-0...<1845::AID-ART17>3.0.CO;2-K PMid:9778226.
Aletaha D, Smolen J. The simplified disease activity index (SDAI) and the clinical disease activity index (CDAI): A review of their usefulness and validity in rheumatoid arthritis. Clin Exp Rheumatol. 2005;23(5 Suppl 39):S100-8. PMid:16273793.
Fransen J, van Riel PLCM. The disease activity score and the EULAR response criteria. Clin Exp Rheumatol. 2005;23(5Suppl 39):S93-9.
Smolen JS, Landewé RBM, Bijlsma JWJ, Burmester GR, Dougados M, Kerschbaumer A, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update. Ann Rheum Dis. 2020;79(6):S685-99. https://doi.org/10.1136/annrhe....
Scott DL, Wolfe F, Huizinga TWJ. Rheumatoid arthritis. Lancet (London, Engl). 2010;376(9746):1094-108. https://doi.org/10.1016/S0140-... PMid:20870100.
Pamukcu M, Izci Duran T, Ulusoy H, Altinbas K. Investigation of the correlation between mood disorder symptoms and disease activity and functional status in rheumatoid arthritis patients. Turkish J Med Sci. 2021;51(6):3008-16. https://doi.org/10.3906/SAG-21... PMid:34773692.
Jung SM, Kwok SK, Ju JH, Lee SW, Song JJ, Yoon CH, et al. Risk factors associated with inadequate control of disease activity in elderly patients with rheumatoid arthritis: Results from a nationwide Korean College of Rheumatology BIOlogics (KOBIO) registry. PLoS One. 2018; 13(10):e0205651. https://doi.org/10.1371/journa....
Ngeuleu A, Allali F, Medrare L, Madhi A, Rkain H, Hajjaj-Hassouni N. Sarcopenia in rheumatoid arthritis: prevalence, influence of disease activity and associated factors. Rheumatol Int. 2017;37(6):1015-20. https://doi.org/10.1007/S00296... PMid:28258473.
Hughes LD, Done J, Young A. A 5 item version of the compliance questionnaire for rheumatology (CQR5) successfully identifies low adherence to DMARDs. BMC Musculoskelet Disord. 2013;14:286. https://doi.org/10.1186/1471-2... PMid:24103582 PMCid:PMC3852995.
Barbich T, Cerda OL, Schneeberger EE, Citera G. Adherence to treatment with tofacitinib in patients with rheumatoid arthritis in daily clinical practice. Reumatol Clínica (English Ed). 2022;18(3):164-8. https://doi.org/10.1016/j.reum... PMid:34301525.
Ubaka CM, Ibe OG, Amorha KC, Isah A, Okonta MJ. Medication adherence among Nigerian patients with rheumatoid arthritis: A two instruments survey. J Pharm Heal Serv Res. 2021;12(1):11-7. https://doi.org/10.1093/jphsr/....
Raymond NZ, Abi Karam G, Salloum N, Zoghbi M. Transcultural adaptation and validation of the Arabic version of the compliance questionnaire for rheumatology. Acta Sci Orthop. 2020;3(10):26-34. https://doi.org/10.31080/asor.....
Horne R, Weinman J, Hankins M. The beliefs about medicines questionnaire: The development and evaluation of a new method for assessing the cognitive representation of medication. Psychol Heal. 1999;14(1):1-24. https://doi.org/10.1080/088704....
Alhalaiqa F, Masa’Deh R, Batiha AM, Deane K. Validity of Arabic version of beliefs about medication questionnaire. Clin Nurs Res. 2015;24(5):539-55. https://doi.org/10.1177/105477... PMid:25106809.
Karamurugan S, Govindarajan B. Statistical package for the social science. Int J Bus Econ Res. 2023;8(4):616-8. ISSN: 2455-3921.
Callahan LF. The burden of rheumatoid arthritis: Facts and figures. J Rheumatol Suppl. 1998;53:8-12.
Au K, Reed G, Curtis JR, Kremer JM, Greenberg JD, Strand V, et al. High disease activity is associated with an increased risk of infection in patients with rheumatoid arthritis. Ann Rheum Dis. 2011 May;70(5):785-91. https://doi.org/10.1136/ARD.20....
Lee YC, Cui J, Costenbader KH, Shadick NA, Weinblatt ME, Karlson EW. Investigation of candidate polymorphisms and disease activity in rheumatoid arthritis patients on methotrexate. Rheumatol. 2009;48(6):613-7. https://doi.org/10.1093/rheuma... PMid:19193698 PMCid:PMC2681284.
Ezerioha M. RF Test: What is the normal range for a rheumatoid factor test? Available at: https://www.rheumatoidarthriti... (Accessed: 30 December 2021).
Aletaha D, Alasti F, Smolen JS. Rheumatoid factor, not antibodies against citrullinated proteins, is associated with baseline disease activity in rheumatoid arthritis clinical trials. Arthritis Res Ther. 2015;17(1):229. https://doi.org/10.1186/s13075... PMid:26307354 PMCid:PMC4549866.
Ho RCM, Fu EHY, Chua ANC, Cheak AAC, Mak A. Clinical and psychosocial factors associated with depression and anxiety in Singaporean patients with rheumatoid arthritis. Int J Rheum Dis. 2011;14(1):37-47. https://doi.org/10.1111/J.1756... PMid:21303480.
van der Heijde DMFM, van Riel PLCM, van Rijswijk MH, van de Putte LBA. Influence of prognostic features on the final outcome in rheumatoid arthritis: A review of the literature. Semin Arthritis Rheum. 1988;17(4):284-92. https://doi.org/10.1016/0049-0... PMid:3068804.
Ince-Askan H, Hazes JMW, Dolhain RJEM. Identifying clinical factors associated with low disease activity and remission of rheumatoid arthritis during pregnancy. Arthritis Care Res (Hoboken). 2017;69(9):1297-303. https://doi.org/10.1002/ACR.23... PMid:27813290.
Tchetina EV, Demidova NV, Karateev DE, Nasonov EL. Rheumatoid factor positivity is associated with increased joint destruction and upregulation of matrix metalloproteinase 9 and cathepsin K gene expression in the peripheral blood in rheumatoid arthritic patients treated with methotrexate. Int J Rheumatol. 2013;2013:457876. https://doi.org/10.1155/2013/4... PMid:24348567 PMCid:PMC3848347.
Mathsson L, Lampa J, Mullazehi M, Rönnelid J. Immune complexes from rheumatoid arthritis synovial fluid induce FcγRIIa dependent and rheumatoid factor correlated production of tumour necrosis factor-α by peripheral blood mononuclear cells. Arthritis Res Ther. 2006;8(3):R64. https://doi.org/10.1186/ar1926 PMid:16569263 PMCid:PMC1526644.
Gonzalez A, Icen M, Kremers HM, Crowson CS, Davis JM, Therneau TM, et al. Mortality trends in rheumatoid arthritis: The role of rheumatoid factor. J Rheumatol. 2008;35(6): 1009-14. PMid:18412312.
Liang KP, Kremers HM, Crowson CS, Snyder MR, Therneau TM, Roger VL, et al. Autoantibodies and the Risk of Cardiovascular Events. J Rheumatol. 2009 Nov 1;36(11):2462-9. https://doi.org/10.3899/JRHEUM....
Böhler C, Radner H, Smolen JS, Aletaha D. Serological changes in the course of traditional and biological disease modifying therapy of rheumatoid arthritis. Ann Rheum Dis. 2013;72(2):241-4. https://doi.org/10.1136/ANNRHE... PMid:23087181.
Wabe N, Lee A, Wechalekar M, McWilliams L, Proudman S, Wiese M. Adherence to combination DMARD therapy and treatment outcomes in rheumatoid arthritis: A longitudinal study of new and existing DMARD users. Rheumatol Int. 2017;37(6):897-904. https://doi.org/10.1007/S00296... PMid:28160071.
Waimann CA, Marengo MF, De Achaval S, et al. Electronic monitoring of oral therapies in ethnically diverse and economically disadvantaged patients with rheumatoid arthritis. Consequences of low adherence. Arthritis Rheum. 2013;65(6):1421. https://doi.org/10.1002/ART.37... PMid:23728826 PMCid:PMC3691007.
Pasma A, Schenk CV, Timman R, et al. Non-adherence to disease-modifying antirheumatic drugs is associated with higher disease activity in early arthritis patients in the first year of the disease. Arthritis Res Ther. 2015;17(1):281. https://doi.org/10.1186/S13075... PMid:26449852 PMCid:PMC4599322.
Nakagawa S, Nakaishi M, Hashimoto M, et al. Effect of medication adherence on disease activity among Japanese patients with rheumatoid arthritis. PLoS One. 2018;13(11):e0206943. https://doi.org/10.1371/JOURNA... PMid:30388179 PMCid:PMC6214559.
Bluett J, Morgan C, Thurston L, et al. Impact of inadequate adherence on response to subcutaneously administered anti-tumour necrosis factor drugs: Results from the biologics in rheumatoid arthritis genetics and genomics study syndicate cohort. Rheumatol (United Kingdom). 2015;54(3):494-9. https://doi.org/10.1093/rheuma... PMid:25213131 PMCid:PMC4334684.
Li L, Cui Y, Yin R, et al. Medication adherence has an impact on disease activity in rheumatoid arthritis: A systematic review and meta-analysis. Patient Prefer Adherence. 2017;11:1343-56. https://doi.org/10.2147/PPA.S1... PMid:28831245 PMCid:PMC5553350.
Fransen J, Laan RFJM, van Der Laar MAFJ, Huizinga TWJ, van Riel PLCM. Influence of guideline adherence on outcome in a randomised controlled trial on the efficacy of methotrexate with folate supplementation in rheumatoid arthritis. Ann Rheum Dis. 2004;63(10):1222-6. https://doi.org/10.1136/ARD.20... PMid:15361375 PMCid:PMC1754779.
Han E, Suh DC, Lee SM, Jang S. The impact of medication adherence on health outcomes for chronic metabolic diseases: A retrospective cohort study. Res Soc Adm Pharm. 2014;10(6):e87-98. https://doi.org/10.1016/J.SAPH... PMid:25088545.
Hamarneh D, Alkhatib N, Denhaerynck K, et al. Gender-stratified hierarchical modeling of patient and physician determinants of antihypertensive treatment outcomes: Pooled analysis of seven prospective real-world studies with 17,044 patients. Curr Med Res Opin. 2021;37(3):367-75. https://doi.org/10.1080/030079... PMid:33467935.
Yusuff KB, Obe O, Joseph BY. Adherence to anti-diabetic drug therapy and self management practices among type-2 diabetics in Nigeria. Pharm World Sci. 2008;30(6):876-83. https://doi.org/10.1007/S11096... PMid:18784982.
Pasma A, Schenk C, Timman R, et al. Does non-adherence to DMARDs influence hospital-related healthcare costs for early arthritis in the first year of treatment? PLoS One. 2017;12(2):e0171070. https://doi.org/10.1371/JOURNA... PMid:28152001 PMCid:PMC5289489.