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Adherence in juvenile rheumatoid arthritis

Clinical bottom line

In a small clinical trial interventions to improve adherence in juvenile rheumatoid arthritis may have a small effect.


Background

Juvenile arthritis is a condition associated with low adherence to treatment. This small randomised trial investigated the effect if a combined educational and behavioural intervention.

Reference

MA Rapoff et al. Prevention of nonadherence to nonsteroidal anti-inflammatory medications in newly diagnosed patients with juvenile rheumatoid arthritis. Health Psychology 2002 21: 620-623.


Study

Children between 2 and 16 years diagnosed with juvenile rheumatoid arthritis within the past year and on stable NSAID therapy for at least one month were studied.Experimental group participants received educational and behavioural strategies for enhancing adherence. There was a 10-minute film, and a booklet. The study nurse reviewed and rehearsed strategies with children and parents. Control patients received a general educational programme about juvenile rheumatoid arthritis. Randomisation to study or control group was with age stratification.

An electronic monitoring system recorded date and time of each bottle opening. This was used for patients primary NSAID, with most prescribed one NSAID with twice-daily dosing.

Results

Fifty-four children were randomised, , with 20 dropping out because they were taken off the medicine, or there was incomplete data, of they withdrew from the study. A per-protocol analysis resulted. Per-protocol groups were comparable at baseline.

Adherence at 52 weeks was higher (78%) in the experimental than the control (57%) group. There were no significant differences in clinical outcomes.

Comment

The tiny size and high dropout rate (40%) in this trial make any results unreliable. It is possible that an educational intervention can help adherence, but that is as much as can be said from the results of this single trial.