Abstract
Despite advances in medical science, poor adherence to long-term therapies remains one of the most significant public health challenges globally. According to the World Health Organization (WHO), adherence to long-term treatment for chronic diseases in developed countries averages only 50% and is estimated to be even lower in developing countries. 1 This low adherence undermines the effectiveness of treatment, increases the risk of disease progression, and leads to higher morbidity, mortality, and healthcare costs.
Medication adherence is a pivotal determinant of therapeutic success of autoimmune diseases including rheumatoid arthritis (RA). Despite availability of several effective disease-modifying agents, poor adherence remains a critical barrier to achieving remission and preventing long-term disability. In this context, a report by Fazel et al. in the current issue of Indian Journal of Rheumatology (IJR), while reporting alarmingly low adherence rates, adds important insight into adherence patterns in a Middle Eastern RA population. Its relevance extends to India, where similar challenges in adherence have been observed in routine clinical settings.2,3 The Indian context is uniquely shaped by a predominantly out-of-pocket healthcare system, wide variability in health literacy, and inconsistent access to specialists.
The study’s registry-based data collection lends credibility to its findings, indicating that age, gender, occupation, and medication type may influence adherence. The observation that women and older adults were more adherent echoes findings from global literature, potentially reflecting health-seeking behaviour and perception of disease seriousness in the patient populations.4,5 Intriguingly, glucocorticoid use was associated with better adherence, possibly due to the immediate symptomatic relief they offer, in contrast to methotrexate, which lacks rapid symptom resolution and may carry unpleasant side effects.
The barriers to adherence in RA are multifactorial, ranging from medication side effects and complex regimens to lack of disease awareness, physician-patient communication, and financial constraints. This complexity calls for a multi-pronged approach. First, adherence assessment tools, such as 8-Item Morisky Medication Adherence Scale (MMAS-8), should be integrated into routine rheumatology practice. Second, patient education must go beyond disease explanation to include motivational interviewing and shared decision-making strategies. 6 Digital health interventions, such as SMS reminders and mobile health apps, are upcoming efficient options in improving adherence in chronic diseases and should be explored further in RA populations.
Last, in 2018, the Empowering Medical and Educational Research through Growth and Excellence (EMERGE) guidelines (European Society for Patient Adherence, Compliance, and Persistence [ESPACOMP] Medication Adherence Reporting Guideline) were developed to improve the quality and consistency of medication adherence research reporting. 7 It provides a structured framework to ensure that adherence-related findings are transparent, comparable, reproducible and enhances the interpretability of studies, facilitates evidence synthesis in meta-analyses, and strengthens the application of adherence data in both clinical trials and routine practice. All future studies should attempt to report using the structure of EMERGE guidelines.
In conclusion, this study is a timely reminder that the success of any therapeutic regimen in RA hinges not only on the choice of drug but also on the patient’s ability and willingness to adhere to it. It is imperative that rheumatologists and healthcare systems shift their focus from simply prescribing medications to supporting patients in sustaining their use. Future research should focus on longitudinal adherence patterns, patient-reported barriers, and the effectiveness of tailored interventions to improve long-term outcomes.