Adherence to Disease Modifying Anti Rheumatic Drugs in Tunisian patients with Juvenile Idiopathic Arthritis: An Observational study.

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Published Mar 30, 2025
https://doi.org/10.62438/tunismed.v103i4.5582
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Vol. 103 No. 4 (2025): Tunis Med Apr 2025

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Alia Fazaa
Department of Rheumatology, Mongi Slim University hospital, La Marsa, Faculty of Medicine of Tunis, University Tunis El Manar,Tunis, Tunisia
Asma Selmi
Rheumatology practice, Nouvelle Médina, Ben Arous,Tunisia
Azza Saad
Department of Rheumatology, Mongi Slim University hospital, La Marsa, Tunisia
Sawssen Miladi
Department of Rheumatology, Mongi Slim University hospital, La Marsa, Faculty of Medicine of Tunis, University Tunis El Manar,Tunis, Tunisia
Hiba Boussaa
Department of Rheumatology, Mongi Slim University hospital, La Marsa, Faculty of Medicine of Tunis, University Tunis El Manar,Tunis, Tunisia
Yasmine Makhlouf
Department of Rheumatology, Mongi Slim University hospital, La Marsa, Faculty of Medicine of Tunis, University Tunis El Manar,Tunis, Tunisia
Kaouther Ben Abdelghani
Department of Rheumatology, Mongi Slim University hospital, La Marsa, Faculty of Medicine of Tunis, University Tunis El Manar,Tunis, Tunisia
Ahmed Laatar
Department of Rheumatology, Mongi Slim University hospital, La Marsa, Faculty of Medicine of Tunis, University Tunis El Manar,Tunis, Tunisia

Abstract

Introduction: Non-adherence or poor therapeutic adherence appears to be particularly prevalent in chronic inflammatory rheumatism, notably in Juvenile Idiopathic Arthritis (JIA). It reduces therapeutic efficacy, accelerates disease progression, and poses a significant public health and economic challenge.


Aim: To evaluate adherence to disease-modifying treatments in Tunisian patients with JIA and to identify factors influencing therapeutic adherence.


Methods: This cross-sectional study included patients with JIA (defined by ILAR criteria) who had been undergoing treatment with conventional synthetic (csDMARDs) and/or biologic (bDMARDs) disease-modifying anti-rheumatic drugs for at least three months. Socio-demographic, clinical, biological, radiological, and therapeutic data were collected. Therapeutic adherence was assessed using two methods: self-reported adherence by patients and their parents, and adherence measured via the Parent Adherence Report Questionnaire (PARQ) and the Child Adherence Report Questionnaire (CARQ).


Results: A total of 30 patients (16 girls, 14 boys) with a mean age of 24.8 ± 11 years [8-47] were included. csDMARDs were prescribed for 76.7% of patients while 26.7% received bDMARDs. Self-reported adherence was 80% among parents and 76.7% among patients. Mean adherence scores were 74.58 ± 36 [0-100] on the PARQ and 74 ± 34 [0-100] on the CARQ. Univariate analysis revealed that adherence measured by the PARQ was positively correlated with erythrocyte sedimentation rate (ESR) (p=0.001; r=0.643) and C-reactive protein (CRP) (p=0.008; r=0.561) and negatively correlated with maternal age (p=0.005; r=-0.572), difficulty in medication administration reported by the parent (p<0.0001; r=-0.698), and negative reactions to medication reported by both the patient (p=0.012; r=-0.506) ...(abstract truncated  at 250 words).

Keywords:

disease modifying anti rheumatic drugs, compliance, adherence, juvenile idiopathic arthritis

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