Background/Purpose: In chronic inflammatory rheumatic diseases (CIRDs), including rheumatoid arthritis, spondyloarthritis, connective tissue diseases and crystal-induced arthritis, long-term adherence to disease-modifying drugs (DMARDs) is only moderate. In 2017, a group of 105 experts developed recommendations to facilitate the evaluation and management of non-adherence to DMARDs in daily practice [1]. Five overarching principles and 10 recommendations were developed [1].

The objective of this study was to evaluate the agreement of French rheumatologists and health professionals (HPs) with these recommendations, their perceived feasibility/ ease of application and participants’ characteristics linked to perceived feasibility.

Methods: Face-to-face meetings were organized across France in 2018 by the program sponsor (Abbvie) with the support of the program committee. During these meetings, the key data and the recommendations were presented and discussed [1]. Participants then informed on paper, their personal data, agreement (from 1 to 5, where 5 is highest) and perceived feasibility (1-5) for each recommendation. Mean agreement and perceived feasibility were calculated for each recommendation. A univariate and multivariate logistic regression identified the characteristics of the participants who rated feasibility the highest (pooled mean above the median).

Results: A total of 38 meetings were held involving 377 physicians/other HPs: 357 (95%) provided analyzable data. The respondents had an average age of 46 years [standard deviation, SD 13]; 223 (63%) were female. Among the 247 (69%) rheumatologists, one third were hospital based (N=90, 37%). Other HPs were nurses (N=81, 23%) or pharmacists (N=14, 4%). Pooled agreement with the overarching principles was very high (mean 4.4 [0.5]). Agreement with the 10 recommendations was also high: pooled mean 4.3 [0.4]; the recommendation with the lowest agreement (mean 3.9 [0.9]) was recommendation 3 on assessing adherence by complex methods. Perceived feasibility was lower (pooled mean 3.4 [0.5]) with a range of means from 2.8 [0.9] (recommendation 3) to 3.9 [0.9] (recommendation 2: assess adherence by an open-ended question). More than 30% of participants rated the feasibility as low (score 1 or 2) for recommendations 3 and 8 (specific intervention in case of non-adherence). The only factor correlated with greater perceived feasibility was being a HP other than a rheumatologist: odds ratio 2.52 [95% confidence interval 1.23-5.15], while age, gender and type of exercise were not significant. Thus, perceived feasibility seemed higher among non-physician HPs, which may be due to the selection of HPs with a strong interest on patient education.

Conclusion: French HPs are in agreement with recently-published recommendations for the evaluation and optimization of adherence to DMARDs [1]. However, feasibility was lower, especially with regard to complex evaluation of non-adherence, and targeted interventions. This initiative has contributed to the dissemination of the recommendations; the next step will be their implementation.

[1] L. Gossec et al. Joint Bone Spine. 2019;86(1):13-19.

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