Adherence to Disease Modifying Anti Rheumatic Drugs in Tunisian patients with Juvenile Idiopathic Arthritis: An Observational study.

Abstract

INTRODUCTION: Non-adherence or poor therapeutic adherence appears to be particularly prevalent in chronic inflammatory rheumatism, notably in Juvenile Idiopathic Arthritis (JIA). It reduces therapeutic efficacy, accelerates disease progression, and poses a significant public health and economic challenge. AIM: To evaluate adherence to disease-modifying treatments in Tunisian patients with JIA and to identify factors influencing therapeutic adherence. METHODS: This cross-sectional study included patients with JIA (defined by ILAR criteria) who had been undergoing treatment with conventional synthetic (csDMARDs) and/or biologic (bDMARDs) disease-modifying anti-rheumatic drugs for at least three months. Socio-demographic, clinical, biological, radiological, and therapeutic data were collected. Therapeutic adherence was assessed using two methods: self-reported adherence by patients and their parents, and adherence measured via the Parent Adherence Report Questionnaire (PARQ) and the Child Adherence Report Questionnaire (CARQ). RESULTS: A total of 30 patients (16 girls, 14 boys) with a mean age of 24.8 ± 11 years [8-47] were included. csDMARDs were prescribed for 76.7% of patients while 26.7% received bDMARDs. Self-reported adherence was 80% among parents and 76.7% among patients. Mean adherence scores were 74.58 ± 36 [0-100] on the PARQ and 74 ± 34 [0-100] on the CARQ. Univariate analysis revealed that adherence measured by the PARQ was positively correlated with erythrocyte sedimentation rate (ESR) (p=0.001; r=0.643) and C-reactive protein (CRP) (p=0.008; r=0.561) and negatively correlated with maternal age (p=0.005; r=-0.572), difficulty in medication administration reported by the parent (p0.0001; r=-0.698), and negative reactions to medication reported by both the patient (p=0.012; r=-0.506) and the parent (p=0.001; r=-0.651). Adherence measured by the CARQ was significantly associated with indigent health insurance status (p=0.019). In multivariate analysis, predictors of non-adherence on the PARQ included advanced maternal age (p=0.004), low ESR (p=0.029), and negative reactions to medications (p0.0001). On the CARQ, difficulty in adhering to the treatment regimen (p=0.042) was the only significant predictor. CONCLUSION: This study demonstrates good therapeutic adherence among Tunisian patients with JIA. Predictors of non-adherence included advanced maternal age, low disease activity, negative reactions to medications, and difficulties in following treatment regimens. Educational strategies targeting these factors may improve adherence and enhance patient outcomes.