Evaluation of Adherence to Methotrexate in a Sample of Iraqi Patients with Rheumatoid Arthritis Receiving Anti - TNF Medications

Background: Rheumatoid arthritis is a chronic inflammatory disease. Current treatment guidelines for RA recommend early aggressive management with Disease -modifying antirheumatic drugs. Non -adherence to treatment has been associated with symptom worsening and increased disability. Aim of study: to determine the prevalence level and factors that affect adherence to Methotrexate among Rheumatoid arthritis patients receiving Anti -Tumor Necrosis Factor. Patients & Methods: This cross -sectional study included a total of 100 patients diagnosed as Rheumatoid arthritis according to ACR / EULAR, 2010 criteria. The enrolled patients answered an interview questionnaire regarding socio -demographic, clinical and treatment information survey including the Arabic version of the eight -item Morisky Medication Adherence Scale. Results: According to Morisky scale, 54% of Rheumatoid arthritis patients taking Anti -TNF medications were classified as having low adherence to Methotrexate therapy. During multivariate analysis, Older age patients >45 (p= 0.004), illiteracy (p=0.028), low socioeconomic state (p=0.050), disease duration >10 years (p=0.008), Methotrexate use duration >5 years (p=0.013), Anti -TNF use duration >3 years (p=0.001), presence of side effects (P= 0.025), non -self dependent (P=0.020), and moderate disease activity (P=0.043) were significantly independent risk factors for nonadherence to Methotrexate. Conclusions: Fifty four percent of patients who are using Anti -TNF were classified as low adherent to Methotrexate. Older age >45 years, illiteracy, low socioeconomic state, disease duration >10 years, Methotrexate duration use >5 years, Anti -TNF duration use >3 years, presence of side effects, non -self dependent, and moderate disease activity were significantly independent risk factors for non -adherence.