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Background: Medication non-adherence is one of the most significant factors affecting treatment in clinical practice. It is well-known that various factors may influence adherence. According to questionnaire used in inflammatory diseases, the non-adherence rate ranges from 34% to 93% in patients with rheumatoid arthritis (RA), while this rate is reported to be approximately 75% in ankylosing spondylitis. For psoriatic arthritis (PsA), there are limited studies available, indicating a non-adherence rate between 45% and 76%.
Objectives: This study aimed to evaluate medication adherence and beliefs in patients with PsA using structured questionnaires, while also examining factors associated with adherence. Additionally, we intended to identify predictive factors linked to adherence-related behaviors.
Methods: We included 204 patients diagnosed with PsA at a tertiary rhematology clinic based on the Classification Criteria for Psoriatic Arthritis (CASPAR). A control group comprised 52 patients with rheumatoid arthritis (RA), classified according to the 2010 ACR criteria. Demographic and clinical data, along with current treatments, were gathered using a standardized form. Disease activity and quality of life were assessed using composite indices. Medication adherence was measured using the Brief Medication Questionnaire (BrMQ)), the Rheumatology Medication Compliance Questionnaire (CQR-T), and the 5-question short form CQR-5. Beliefs about medications were evaluated using the Beliefs about Medicines Questionnaire (BMQ) consisting of 18 items.
Results: The age distribution [PsA: 52.9 (11.5), RA: 55.9 (9.8)] and gender (female: 70.6% in PsA vs 82.7% in RA) were similar between groups. Differences were noted in education, smoking status, marital, and employment status. PsA patients exhibited a shorter disease duration compared to RA [11 (9.2) vs 12.9 (10.9), p: 0.018]. PsA patients had a higher mean tender joint count [5.5 (9.7) vs 2.3 (4.7), p: 0.007] but similar swollen joint counts. The DAS28-CRP levels indicated greater disease activity in the PsA group [3.1 (1.3) vs 2.5 (1.0), p: 0.007]. No significant differences in co-morbidity distribution were observed between groups. Leflunomide (26% vs 50%, p: 0.001) and corticosteroid use (21% vs 57.7%, p < 0.001) were higher in RA patients. Biological agent and methotrexate use were comparable between the two groups. Non-adherence rates (BrMQ) were 64% for PsA and 51.7% for RA, with a significantly higher rate of non-adherence due to medication regimen issues in PsA (14.8% vs 3.8%, p: 0.034). CQR-T indicated non-adherence rates of 58.8% for PsA and 48.1% for RA, with a low agreement rate of 45.8% between the questionnaires. The mean belief assessment with BMQ showed higher general harm perception in the PsA group [9.9 (2.9) vs 9.2 (2.6), p: 0.03]. Both groups predominantly consisted of ambivalent patients (high concern-high necessity). No significant differences were observed in clinical characteristics or quality of life when categorized by medication compliance in PsA patients. However, methotrexate use was more prevalent among non-compliant patients (47.2% vs 68.5%, p: 0.003).
Conclusion: High rates of medication non-adherence were observed in both PsA and RA patient groups, with medication regimen and methotrexate use emerging as important factors associated with non-adherence. The predominance of ambivalent patients in both groups suggests a potential impact on adherence. Long-term evaluations concerning non-adherence and patient beliefs could be vital for improving treatment persistence.
REFERENCES: NIL.
Acknowledgements: NIL.
Disclosure of Interests: None declared.
© The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license (