Adherence to disease modifying anti-rheumatic drugs among rheumatoid arthritis patients attending the Kenyatta National Hospital Rheumatology Clinic

Abstract

Background: Rheumatoid Arthritis (RA) is a chronic multi-systemic disease characterised by inflammation of the synovial membranes of the joints. The cornerstone of treatment is with Disease Modifying Anti Rheumatic Drug (DMARD) therapy which includes synthetic and biologic agents. Adherence to RA treatment can be challenging as management requires a complex longterm interplay between the treating physician, medications used, the patient as well as their families and care-givers. Multiple factors contribute to variable adherence to therapy leading to treatment goals not being met. Assessing treatment adherence is therefore key to identifying and addressing the root causes of nonadherence.
Objective: To evaluate treatment adherence and clinical disease activity among rheumatoid arthritis patients attending the Kenyatta National Hospital Rheumatology Outpatient Clinic.
Methods: This was a descriptive crosssectional study carried out at the Kenyatta National Hospital Rheumatology Outpatient Clinic. We recruited patients over the age of 18 years with a diagnosis of rheumatoid arthritis as diagnosed according to the 2010 ACR criteria on file and who had been on at least one DMARD for at least three months. The study tools that were used included a study proforma, the 5 item compliance questionnaire of rheumatology (CQR-5) to assess adherence and the Clinical Disease Activity Index (CDAI) to assess disease activity.
Results: A total of 97 patients, were recruited, 84.5% of whom were female and the mean age was 53.9 years. The overall level of adherence was 49.5% with a mean CQR-5 score (SD) of 15.8 (1.7). Moderate disease activity was noted in 85 (87.6%), patients 5 (5.2%) patients had low disease activity while 7 (7.2%) patients had high disease activity. No patient scored low enough to be categorized as being in remission. There was a significant association between age less than 62 years and adherence to DMARD therapy (p=0.032).
Conclusion: The level of adherence to DMARD therapy was lower than global averages and WHO recommendations. Most patients had moderate to high disease activity while no patients were found to be in remission. There was no statistically significant association between adherence to medication and disease activity.