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Rheumatoid arthritis patients not taking their medications as prescribed

A new study conducted in an ethnically diverse and predominantly low income population found that only one-fifth of rheumatoid arthritis (RA) patients had an overall adherence rate to prescribed oral medications at 80% or greater.

Findings published today in Arthritis & Rheumatism, a journal of the American College of Rheumatology (ACR), indicate that less than two thirds of medication regimens for non-biologic disease modifying anti-rheumatic drugs (DMARDs) were correctly followed by RA patients.

According to ACR estimates, more than one million U.S. adults experience inflammation, pain, tenderness and swelling of the joints caused by RA. While there have been advances in RA treatments—biologic therapies such as the tumor necrosis factor (TNF) inhibitors adalimumab (Humira®), etanercept (Enbrel®), and infliximab (Remicade®)—oral DMARDS, namely methotrexate, remain the gold standard for treating those with RA. In fact, previous research has shown that biologics are more effective when taken with methotrexate, but patients must follow the prescribed medicine regimens to realize the full benefits.

For the present study, Drs. Christian Waimann, Maria Suarez-Almazor and colleagues from The University of Texas MD Anderson Cancer Center, in Houston enrolled 107 RA patients in a two-year study that electronically monitored their intake of oral RA medications. Measures of DMARD adherence were:

Doses taken as prescribed: Percentage of days or weeks for methotrexate or prednisone in which the patient took the correct dose as prescribed
Underdosing: Percentage of days or weeks in which the patient took fewer doses than prescribed
Overdosing: Percentage of days or weeks that the patient took more doses than prescribed

Of those who participated, 87% were female with a mean disease activity of 8 years. The RA patient group was ethnically diverse with 65% Hispanic, 19% African-American and 16% Caucasian. Educational status was low with 45% not completing high school and 67% having incomes less than $20,000.

RA patients who took their medications as prescribed were considered adherent—64% for DMARD therapy and 70% for prednisone. Only 21% of participants adhered to their DMARD therapy and 41% correctly took prednisone at least 80% of the time. Patients who took their medications as prescribed showed significantly lower disease activity scores (DAS28 at 3.3) throughout the study period compared to those who were less adherent (DAS28 at 4.1). Increases in radiological damage score were also higher in RA patients who were non-adherent.

Researchers report that adherence to oral DMARDs and steroid therapy in RA patients with RA was low, ranging from 58% to 71%, but patients who had better mental health status and were not widowed or separated were more likely to adhere to their medication regimen. "Our study is the first to measure drug adherence in RA patients over the long-term, and emphasizes the importance of following the prescribed regimen to manage their disease," concludes Dr. Suarez-Almazor. "Physicians should work with patients to understand their reasons for non-adherence and discuss the importance of taking medications as prescribed to control RA symptoms and prevent disease progression."

This study is published in Arthritis & Rheumatism. Media wishing to receive a PDF of this article may contact

Full citation: "Electronic Monitoring of Oral Therapies in Ethnically Diverse and Economically Disadvantaged Patients with Rheumatoid Arthritis." Christian A. Waimann, Maria F. Marengo, Sofia de Achaval, Vanessa L. Cox, Araceli Garcia-Gonzalez, John D. Reveille, Marsha N. Richardson, Maria E. Suarez Almazor. Arthritis & Rheumatism; Published Online: May 30, 2013 (DOI: 10.1002/art.37917).


About the Author: To arrange an interview with Dr. Suarez–Almazor, please contact Julie Penne at MD Anderson at +1 713-792-0662 or

About the Journal

Arthritis & Rheumatism is an official journal of the American College of Rheumatology (ACR) and covers all aspects of inflammatory disease. The American College of Rheumatology ( is the professional organization whose members share a dedication to healing, preventing disability, and curing the more than 100 types of arthritis and related disabling and sometimes fatal disorders of the joints, muscles, and bones. Members include practicing physicians, research scientists, nurses, physical and occupational therapists, psychologists, and social workers. The journal is published by Wiley on behalf of the ACR. For more information, please visit

About Wiley

Wiley is a global provider of content-enabled solutions that improve outcomes in research, education, and professional practice. Our core businesses produce scientific, technical, medical, and scholarly journals, reference works, books, database services, and advertising; professional books, subscription products, certification and training services and online applications; and education content and services including integrated online teaching and learning resources for undergraduate and graduate students and lifelong learners.

Founded in 1807, John Wiley & Sons, Inc. (NYSE: JWa, JWb), has been a valued source of information and understanding for more than 200 years, helping people around the world meet their needs and fulfill their aspirations. Wiley and its acquired companies have published the works of more than 450 Nobel laureates in all categories: Literature, Economics, Physiology or Medicine, Physics, Chemistry, and Peace. Wiley's global headquarters are located in Hoboken, New Jersey, with operations in the U.S., Europe, Asia, Canada, and Australia. The Company's website can be accessed at

Dawn Peters | EurekAlert!
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