Background/Purpose: To assess adherence to treatment in patients with Systemic Lupus Erythematosus (SLE) and to determine its relationship with social, educational levels and disease activity.

Methods:  Prospective cross-sectional study. We included consecutive SLE patients (ACR 1997 criteria), over 18 years old , between April and July 2014, receiving at least one specific drug for the disease. Socioeconomic and educational status (education level, years of effective education, social coverage, and socioeconomic status according Graffar scale) – demographic variables (age and sex), related to the disease (time of evolution, current medication and polypharmacy), were studied. To assess adherence to oral medication CQR self-questionnaire was used, and Morisky Green for hydroxychloroquine, steroids and other immunosuppressants (methotrexate, azathioprine, mycophenolate mofetil, cyclophosphamide). Adherence to parenteral medication (cyclophosphamide, methotrexate, rituximab and belimumab) it was made through direct observation. We excluded patients with severe visual impairment and / or previous neurocognitive impairment that could not complete those self-questionnaires. Statistical analysis: Descriptive statistics. Chi-square test and Fisher test, Pearson/Spearman correlation coefficient test and logistic regression model was used.

Results: One hundred and ten patients were includes, 91% female, mean age 37 (± 12.5) years, mean duration of disease of 9.9 (± 7.8) years, mean SLEDAI and SLICC was 2.07 (± 3.3) and 0.9 (± 1.5) respectively. Effective education years were 11.4 (± 4.1) and only one patient was unlearned. Fourty percent of patients were unemployed at the time of the study; 55% had public social coverage but providing medication to 100%; 57% of patients had lower socioeconomic level (50% mid to lower and 7% lower), and certificate of disability from their disease. Eighty percent of patients were receiving hydroxychloroquine, 65% steroids and 20% MMF as immunosuppressant oral more used; 86% of patients were polymedicated. Adherence to treatment, assessed by MG was good for most patients (57% to hydroxychloroquine, 63% to steroids and 56% to other immunosuppressants, respectively). The main cause of lack of adherence to medication was forgetfulness of taking them (24%); 63% of patients had good overall adherence assessed by CQR. Patients with less education level had lower adherence to receive hydroxychloroquine (p ≤ 0.0001). Polypharmacy patients had lower adherence to oral steroids (p ≤0.02). Adherence to treatment was not associated with age, duration of disease, SELENA SLEDAI, SLICC DI, socioeconomic status or occupation.

Conclusion: Global adherence to treatment in lupus patients was good, evaluated by MG and CQR. Lower educational level was associated with lower adherence to treatment with hydroxychloroquine. Polypharmacy patients had lower adherence to use of oral steroids. Lack of adherence to treatment was not associated with age, duration of SLE, SELENA SLEDAI, SLICC DI, socioeconomic status, or occupation.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/adherence-to-treatment-and-social-educational-levels-in-patients-with-systemic-lupus-erythematosus/