Pediatric Rheumatology Online Journal → June 2003 → Miscellaneous Topics→ Abstract #77

ADHERENCE TO TREATMENT IN JUVENILE IDIOPATHIC ARTHRITIS

C. M. Duffy,1,2 M. De Civita,2 M. Gibbon,1 P. Dobkin,2 R. Scuccimarri,1,2 K. N. Duffy,1,2 M. Geoffrion,1 A. Brownstein,1 D. Ehrmann-Feldman.1,3

1Rheumatology, Montreal Children's Hospital, Montreal, Canada; 2McGill University, Montreal; 3Universite de Montreal

Objective: To identify factors associated with adherence to prescribed medications and exercises in patients with JIA. This study represented a sub-study in a larger outcome study in 200 patients. Methods: All patients attending the JIA clinic at our institution who had been prescribed medications and/or exercises were eligible to participate. Parents of those consenting to enroll completed the Patient Adherence Report Questionnaire (PARQ), a global adherence scale (visual analog scale) and an adherence log over a 3 month period. Physicians and therapists also completed an adherence scale (VAS) at 3 months. Additional data on disease activity status [active joint count (AJC), sum of joint severity score (SJSS) were completed at baseline and at 3 months. Results: Fifty-one JIA patients participated (Oligo 18, poly 15, systemic 4, enthesitis-related 6, psoriatic 4, other 4). Mean age was 11.2 yrs, mean disease duration 5.1 yrs, 71% were female, with a mean AJC 4.4, and mean SJSS 11.2 at baseline. All patients were prescribed medications, as follows, NSAIDs alone 24, methotrexate plus NSAIDs 13, methotrexate alone 10, other 4. Thirty two were prescribed exercises. Patient logs showed a mean of 75.2% adherence with medications, but only 52.2% with exercises. Correlations between patient logs and other measures of adherence were 0.75 (p=0.0001) and 0.69 (p=0.001) for medications; and 0.57 (p=0.03) and 0.48 (p=0.07) for exercises. Determinants of good adherence with medications were fewer medications (p=0.009), older age (p=0.11) and higher SJSS (p=0.12); and with exercises were lower SJSS (P= 0.01), more exercises (p=0.03) and younger age (p=0.11). Conclusion: Adherence with treatment in JIA is variable being better with medications than exercises. Different factors seem to influence adherence with different treatments and this requires further study to ascertain if these factors might be amenable to intervention.