الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Rheumatoid arthritis (RA) is an autoimmune disease that causes inflammation of the joints. It has a strong impact on people’s everyday lives. Patients with RA suffer from pain, limited mobility and disability and experience a decreased quality of life).Disease Modifying Anti-Rheumatic Drugs (DMARDS), most commonly methotrexate and others, such as leflunomide, hydroxychloroquine, and sulfasalazine remain the cornerstone of therapy in RA and are invariably used as initial therapy(217). The American College of Rheumatology recommends intervention with biologic DMARDs for intermediate and long duration for patients with moderate disease activity, poor prognosis, and inadequate disease response to nonbiologic DMARDs (methotrexate), and for patients with high disease activity regardless of their prognosis(231). Adherence defined as the extent to which a patient’s actual dosing corresponds to the prescribed dosing regimen, from initiation until the last dose is taken(8). Patient factors that reportedly affect adherence include medication side effects, socioeconomics, complexity of the medication regimen, healthcare self-efficacy, knowledge of the medication and disease, and the patient’s perception of medication efficacy(14).Demographic variables such as age and ethnicity have been described as factors affecting medication adherence in patients with RA(15). Previous studies have reported that DMARDS nonadherence results in more disease activity, loss of function, and a lower quality of life(9, 10). It is crucial for health care providers to assess the patient, predict the possible causes of non-adherence, put a policy for increasing medication adherence and achieving the best health outcome. Also, improving medication adherence enhances patient’s safety and health condition(20). Aim of this study determining adherence rate to DMARDS.Find the correlation between the adherence rate and some clinical parameters and disease activity. Predicting factors affecting treatment adherence among sample of Egyptian patients with RA. This study included Seventy three adult RA patients from both sex who fulfilled the 2010 ACR/EULAR classification criteria for RA All the patients were subjected to the following Full history and full clinical examination. Assessment of disease activity using (DAS-28 ESR scoring). Assessment of socioeconomic status of the family using socioeconomic status scale. Assessment of the reported medication adherence behavior using MMAS-8 score. Assessment of functional disability using HAQ-DI score. Detection of depression and anxiety using HADS score. The following results were obtained: There were no significant difference between medication adherence and demographic characteristics, socio-economic class, DAS-28 ESR, disease duration, treatment duration and comorbidity. There was a significant correlation between socioeconomic status, DAS-28, depression and anxiety with functional disability (p = 0.036, 0.000, 0.000 and 0.010) respectively. While there was no statistically significant correlation between clinical data and functional disability. There was a statistically significant correlation between DAS-28 and depression/anxiety (p = 0.017/ 0.002) respectively. While there was no statistically significant correlation between clinical data and depression/anxiety. There was a significant correlation between age, marital status and educational level with socioeconomic class (p =0.022, 0.000 and 0.000) respectively. While there were no statistically significant correlation between sex, residence, clinical data and DAS-28 and socioeconomic class. There was a significant correlation between sex and DAS-28 (p = 0.031). While there were no statistically significant correlation between other items of demographic characteristics and clinical data and DAS-28. It could be concluded that: Medication adherence in studied patients showed positive correlation with socioeconomic class and disease activity measured b DAS-28 ESR, while it had no significant relation with clinical data. Significant positive correlations were also found between DAS-28 ESR and functional disability, depression and anxiety, while correlation was lacking between DAS-28 ESR and socioeconomic level. Negatively significant correlation was found between socioeconomic and functional disability. It has been recommended that: Creation of awareness and educational programs regarding the course of the disease and necessity of continuous treatment with proper follow up and monitoring with stress on proper compliance /adherence to the prescribed therapy to avoid the morbidity and mortality in the patients of RA. Essentials for delaying the onset of disabilities are controlling disease activity, enhancing functional exercises and strengthening psychological education. The patient’s disease activity should be treated not only to prevent any destruction of joints but also with regard to their specific co-morbid disease(s).