Advances in rheumatoid arthritis treatment in recent years have helped patients with RA better relieve symptoms, reduce complications and, in many cases, slow or stop disease progression and prevent permanent joint damage. Yet, even the best treatments can’t help if you do not take them correctly and consistently. Unfortunately, research shows that correct and consistent use of – or adherence to -- RA medications is the exception rather than the rule.

A 2013 study published in Arthritis & Rheumatism found that just over one in five patients took their oral medications correctly at least 80 percent of the time, says study leader Maria Suarez-Almazor, MD, PhD, chief of rheumatology at the University of Texas MD Anderson Cancer Center in Houston. The study involved an ethnically diverse and predominantly low-income population treated at MD Anderson.

Studies demonstrating a lack of adherence to RA medications date back many years.  A 2000 Joint Bone Spine article concluded that, among 429 patients on RA prescribed medications over the full course of the study, only 35.7 percent took their prescribed medications correctly and consistently.  

The health risks of non-adherence can be high. In the MD Anderson study, patients with RA who did not take their medication consistently had significantly higher disease activity scores compared to those who did. They also had greater increases in joint damage as seen on x-rays. “We wanted to see if lower adherence was related to poorer outcomes and that basically is what we found,” says Dr. Suarez-Almazor.

The consequences of non-adherence may be even more concerning for people with RA who are prescribed medications to reduce complications of the disease. For example, a 2012 study published in Arthritis Care & Research found that RA patients who were prescribed cholesterol-lowering drugs called statins but stopped taking them had a 60% increased risk of dying from cardiovascular disease. Among the 4,000 study patients who were prescribed statins over four years, 45 percent had stopped taking their medications for three months or longer.

Top Reasons for Non-Adherence

While studies focusing on adherence do not give clues to why people do not take their medicines as directed, Dr. Suarez-Almazor – who has studied this topic extensively -- has found the reasons often fall into one of the following categories:  

Logistical:  Some patients might not have transportation to the pharmacy, or they do not have someone to pick up their medication for them.

Financial: A medicine may be too expensive, even when insurance covers part of the cost.   For example, biologic medicines used to treat RA can cost thousands of dollars per year. Some insurers have changed rules regarding biologic coverage, and patients must now pay 20 to 50 percent of the drug cost, instead of the standard copay required for most other medications. “This practice goes against the basic premise of insurance and is causing many patients to underutilize necessary treatment or go without treatment entirely,” according to a press release from the American College of Rheumatology.