Background/Purpose: Treatment adherence is fundamental for adequate control of rheumatic diseases. Nevertheless, due to the chronic nature of these conditions, polypharmacy can impact treatment adherence, which leads to temporary remission for most patients. In patients with these conditions, there tends to be a relationship between disease progression and quality of life deterioration. We aimed to evaluate the impact of polypharmacy on treatment adherence and its effect on the quality of life in patients with rheumatic diseases.

Methods: A cross-sectional, observational study was conducted at an outpatient rheumatology clinic. Patients >18 years old and with a rheumatic diagnosis were included. Polypharmacy was defined as a medication intake ≥ 5. Treatment adherence was evaluated by
Morisky-Green test, considering adherence in patients with a score ≥ 3 and non-adherence in patients with a score < 3. To assess the quality of life, we employed 5Q-5D-3L, with: mobility, self-care, daily activities, pain, and anxiety/depression; each one with three stages: no problems, some problems, and severe problems, and a visual analog scale to evaluate their perceived general health state (EQ-5D-3L-VAS). Descriptive analysis was performed. Chi-Square and Mann-Whitney´s U tests were applied as appropriate to compare the outcomes across the various scales. A p-value < 0.05 was considered statistically significant.

Results: A total of 149 patients were included, of whom 142 (95.3%) were women, with a median age of 55 (IQR: 46-65). The most common diagnosis was rheumatoid arthritis (n=73/49%), followed by systemic lupus erythematous (n=27/18.1%), and Sjogren’s syndrome
(n=14/9.4%). The median number of medications taken was 5 (IQR: 4 -8), with 39.6% of them being DMARDs. Polypharmacy was found in 97 patients (65.1%). The most common comorbidity was arterial hypertension (n=49/32.9%), followed by diabetes mellitus
(n=19/12.8%). Most patients referred had an adequate treatment adherence (n=112/75.2%). More than half of our patients have poor treatment adherence (n=87/58.4%). Forgetfulness and drug accessibility were the main causes of non-adherence in these patients in 22.1% and 14.1%, respectively.
There was no relationship in diagnoses, comorbidities, salary, and occupation when comparing patients with adequate and poor adherence. Patients with non-adherence had significantly higher medication intake than those with suitable treatment adherence (6 [4-8] vs. 3.5 [2-5]; p= < 0.001). In quality-of-life domains, such as mobility, self-care, usual activities, and pain, patients with non-adherence had a significantly worse outcome regarding their quality of life compared to patients with good treatment adherence (Table 1). Patients with adequate adherence had a higher score on self-perceived quality-of-life, evaluated by EQ5DL3-VAS (p= < 0.001) (Figure 1).

Conclusion: Patients with nonadherence have a negative impact on their quality of life regarding mobility, self-care, usual activities, and pain compared to patients with adequate adherence. It is necessary to consider the implications of additional medication intake in rheumatic patients, as it may affect their quality of life.

Figure 1: Results of 5Q-5D-3L-VAS, which assesses patients’ perceived quality of life, stratified by adherence and non-adherence groups, showing better reported quality of life in patients with greater adherence.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/impact-of-polypharmacy-on-treatment-adherence-and-its-effect-on-the-quality-of-life-in-patients-with-rheumatic-diseases/