Background/Purpose: In rheumatoid arthritis (RA), up to 80% of patients were found to be non-adherent to prescribed medication and non-pharmacological interventions. These patients do not reach optimal clinical outcomes. In the present study, we therefore explored predictors that may lead to non-adherence from the perspective of patients.

Methods: In a mixed-methods study, retrospective, observational data from patients with RA diagnosed according to the EULAR/ACR criteria with at least one DMARD therapy who failed to attend to the follow-up visits for at least 9 months (and were thus considered to be potentially non-adherent to recommended interventions) were selected from the databases of two rheumatology centers. Subsequently, we invited all these patients to take part in a qualitative semi-structured interview study with a meaning condensation data analysis. Based on the interviews, patients were assigned to the sub-groups ‘adherent’ (e.g. having regular rheumatology visits in another clinic) or ‘non-adherent’ (e.g. having stopped taking the prescribed medication and interventions).  Possible predictors derived from the qualitative analysis and clinical variables obtained from the patient databases of the centers were tested in a logistic regression model.

Results: In total, data of 459 eligible patients (346 [75.4%] females; total mean age 63.0 [SD 14.8]) were identified. One hundred thirty one of these (109 [83.2%] females; total mean age 64.8 [SD 14.1]) agreed to participate in the qualitative interviews. In addition to already known themes, new issues important to patients emerged from the qualitative analysis (table 1):  (i) the so-called “patient’s dogma” inhibited adherent behavior, in that patients felt that pain was an important part of life and attributed this to having had a high manual workload during life of which patients were proud; (ii) patients trusted physicians who were seeking support from other physicians less, because they appeared to be “young or unexperienced”; (iii) some patients did not feel properly understood if physicians only prescribed medication without offering advice on non-pharmacological aspects of treatment. Two clinical variables were also found to be predictors for non-adherent behavior: higher number of swollen joints (OR 0.9; CI 95% 0.8-1.0) are associated with a higher likelihood of non-adherence, whereas older patients (OR per decade 1.3; CI 95% 1.0-1.7) were more likely adherent.

Conclusion: The predictors for non-adherence may be used to improve patients’ counseling and to enhance patient adherence and improve clinical outcome in pharmacological and non-pharmacological interventions.

Table 1. Qualitative results.