Background/Purpose: Medication adherence is instrumental for the successful management of rheumatoid arthritis (RA) to a goal of remission. Awareness of medication necessity and concerns regarding its use influence adherence and respectively foster or undermine the achievement of treatment goals. We here explored the unique and interactive roles of patient beliefs about the necessity of RA medications and concerns about them in predicting adherence to prescribed treatments.

Methods: We evaluated 316 patients with established RA from a single center. Beliefs about the necessity of RA medications and concerns regarding their use were evaluated with the Beliefs about Medicines Questionnaire-Specific (BMQ) Necessity and Concerns scales (range 5-25). Self-reported rheumatoid arthritis treatment adherence was assessed using the Simplified Medication Adherence Questionnaire (SMAQ, range 0-6). Multivariable linear regression evaluated the effects of necessity, concerns and their interactions with adherence. A latent profile analysis (LPA) subsequently classified patients in groups according to patterns of necessity and concerns; adherence scores were then compared across latent groups using analysis of covariance (ANCOVA). 

Results: Full adherence (SMAQ score 6/6) was reported by 101 (32%) patients. Necessity and concerns had independent and opposing contributions to adherence (β=0.21 and β=-0.28 respectively, both p< 0.001, figure 1a) even after adjustments for age, gender and disease duration. An interaction between necessity and concerns with adherence was also observed (p=0.009); post-hoc simple-slope tests indicated that necessity predicted adherence in the context of increasing concerns. The Johnson-Neyman technique revealed that while concerns were significantly associated with adherence across the entire range of necessity scores,necessity was significantly related to adherence only at high BMQ Concerns scores (³13 ).LPA revealed four latent patient groups (figure 1b): Low necessity/ Low concerns (indifferent, n=33), Low necessity/ High concerns (skeptical, n=70), High necessity/ High concerns (ambivalent, n=92) and High necessity/ Low concerns (accepting, n=121). Adherence varied across groups even after adjusting for between-group differences (p=0.002, Figure 1c); adherence was highest in the accepting group and lowest in the skeptical group.

Conclusion: The relationship between necessity and concern beliefs regarding RA medications significantly influences adherence behavior and may further direct physicians to effectively tailor their education efforts in diverse patient groups. A message aimed at reducing concerns might be more effective in the ambivalent group, whereas emphasizing medication necessity may be more fruitful in the skeptical group.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/medication-necessity-and-concerns-beliefs-are-distinct-interactive-predictors-of-treatment-adherence-in-rheumatoid-arthritis/