Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
The therapeutic compliance (TC) is a major issue for the management of Juvenile Idiopathic Arthritis (JIA). The chronic nature of this inflammatory rheumatism requires a strong ability of the child to follow his treatments, where the parental involvement and the link built with the caregiver are essential. The Therapeutic Alliance (TA) measures the multifaceted caregiver-clinician relationship. We hypothesized, that in JIA, TA, that describes the relationship between the child and his (her) therapist, should be a key factor of TC. The aim of this study was to evaluate the link between TA and TC in a large JIA cohort.
Observational, cross-sectional, multicenter study, in 13 reference centers in France. During a routine consultation, the physicians, rheumatologists or pediatricians, distributed questionnaires to both the children and their parents. Each child, his(her) parents and the physician completed the HAQ-CP TA questionnaire, assessing TA. TC was measured through the Child Adherence Report Questionnaire (CARQ), the Parent Adherence Report Questionnaire (PARQ) and the Morisky questionnaire. Children aged 6 to 18 were included. The treatments , their tolerance, the disease activity and the socio-professional environment of the parents were collected. The univariate relationship between TA and TC, were studied by Pearson correlation coefficient. The multivariate analysis used a multiple linear regression model. 105 patients had to be included to highlight a relationship with a power of 90% at risk alpha 5%.
119 children (70% girls), age(SD) 12.4(2.9) were included. The JIAs were oligoarticular (28.6%) or polyarticular (type). The mean disease duration was 73.1 (48.2) months. TA scores were high for parent (86/100), child (84/100) and therapist (80/100). There was a significant correlation between the child’s TA and TC (r=0.31; p=0.0009) and between that of the parent and the child’s compliance (r=0.37; p<0.0001). About factors influencing TC, lifestyle in rural areas was statistically associated to a better adherence (p=0.0229) whereas female sex was a factor of poor compliance (p= 0.04). A poorer child’s TA was found when the disease was active (p=0.048), when the parents were divorced (p=0.01) and in case of sub-urban than in case of rural residence (p=0.004). For the parent, TA varied according to the JIA sub-group (p=0.003), with lower TA in polyarticular JIA (p=0.005). For the therapist, TA varied according to the JIA sub-group with poorer TA in extended polyarticular JIA (p=0.0326). A poorer TA was observed when the disease had been evolving for a long time (p=0.0008) and the follow-up was long (p=0.004).
In JIA, the treatment compliance is highly related to the therapeutic alliance between the child and his (her) therapist. However TA varied widely according to the disease specificities and the child’s lifestyle. This must be known by rheumatologists and pediatricians, to improve the adherence to treatment.
To cite this abstract in AMA style:Devauchelle-Pensec V, Lohse A, Guillemin F, Solau-Gervais E, Rossi-Semerano L, Duquesne A, Lemelle I, Pillet P, Ballot C, Goumy L, Tran TA, Sparsa L, Reumaux H, Arbault A, Alleyrat C. The Therapeutic Alliance Is Associated with a Better Therapeutic Adherence in Children with Juvenile Idiopathic Arthritis: Results of a French Multicenter Study [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/the-therapeutic-alliance-is-associated-with-a-better-therapeutic-adherence-in-children-with-juvenile-idiopathic-arthritis-results-of-a-french-multicenter-study/. Accessed November 23, 2020.
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