Effect of early treatment with disease-modifying anti-rheumatic drugs and treatment adherence on disease outcome in rheumatoid arthritis patients

Aim of the work To evaluate the effects of early and regular treatment with Disease Modifying Anti-Rheumatic Drugs (DMARDs) on disease outcome in rheumatoid arthritis (RA) patients and factors affecting adherence to treatment. Patients and methods Sixty-four RA patients (83% females, mean age 42.9 ± 11.9 and disease duration 4.5 ± 2 years) were divided into Group A (n = 31) who received DMARDs within 6 months of symptom onset and Group B (n = 33) who received DMARDs later in the disease course. Patients were assessed by the disease activity score DAS28, the Modified Health Assessment Questionnaire-Disability Index (MHAQ-DI), the Physical Component Summary (PCS) and Mental Component Summary (MCS) of the Short Form-36 and scoring of radiological damage by modified Larsen's method. Adherence was assessed by self-report and physician judgment. A questionnaire including the most important factors that may affect early and regular treatment by DMARDs/appointment keeping of follow up visits was administered to the patients. Results The adherence rate was 62.5%. Group A patients had significantly lower DAS28, MHAQ-DI, radiological scores (P = 0.001 for all), higher PCS (P = 0.001) and MCS (P = 0.003) scores than group B patients. Among groups A and B, adherent patients had significantly lower DAS28 (P = 0.001 for both) and higher PCS (P = 0.002 and 0.04, respectively) than non-adherent patients. Rural residence, lack of awareness about the disease and lack of belief in medication effectiveness were the most important factors associated with non-adherence (p = 0.04, 0.03 and 0.045, respectively). Conclusion Early treatment and adherence to DMARDs have an important impact on disease outcome in RA patients.