POS0481 DOES OLDER REALLY MEAN WISER?
Authors: D. Khalifa, S. Belghali, M. Limam, N. El Amri, K. Baccouche, H. Zeglaoui, E. Bouajina
Journal: Annals of the Rheumatic Diseases (2021)

Background: One of the main challenges in Rheumatoid arthritis (RA) is to maintain remission or low disease activity by adhering to the prescribed treatments. However, it is believed that adherence to long term treatments is inadequate in chronic diseases. Does this apply to older people too? Objectives: To assess treatment adherence among an elderly RA population and to study determining factors of non-adherence Methods: A cross-sectional study over a period of 4 months was conducted in a rheumatology clinic (September 2020-December 2020). Consenting elderly over the age of 65 presenting with RA were included. Exclusion criteria involved associated connective tissue diseases and troubles communicating. During clinical visits, sociodemographic information, clinical, radiological and therapeutic data were collected. Treatment adherence was assessed by the 5-item compliance questionnaire of rheumatology (CQR-5). Patients were also asked about the degree of satisfaction vis-à-vis the therapeutic effect detected. Univariate and multivariate analysis were conducted using the statistical tool SPSS.20. Results: Forty patients consented to join the study, 82.5% of them were women. The median of age was 66.5 years old with a minimum of 65 and a maximum of 83. Comorbidities were noted in 55% of the patients. 75% of the patients had health insurance. The mean pain score was 5 out of 10 on a visual analog scale (VAS). The mean DAS 28 was 4.65±1.77 with 72.5% of the patients having an active disease. Deformities were reported in 60% of the cases and bone destruction on radiographs in 87.2% of the cases. Methotrexate was the most prescribed treatment in 95% of the cases and biologics in 12.5% of the cases. The median number of pills taken (on the day of MTX) was 12.5 (min=6; max=23). Up to 35.5% of the patients were not satisfied with treatment results. 90% of the patients took their medication because they had fewer problems afterwards. 72.5% of them did not dare to miss their RA treatment. 95% of them had their pills stored in the same place to not forget them, 97.5% took their medication because they had complete confidence in their rheumatologist and 92.5% of them hung on to what the doctor told them. The overall results of the CQR-5 revealed that 72.5% of the patients were adherent to their RA medication and 27.5% of them were non-adherent. The study of factors associated to non-adherence showed that being younger (p=0.01), not having a health insurance (p=0.014), having comorbidities (0.03), and not being satisfied with treatments’ results (p=0.014) were associated to non-adherence. Multivariate analysis showed that risk factors associated to non-adherence were elevated pain scores (odds ratio=4.11, p=0.042), not having health insurance (odd ratio=7.54, p=0.006) and having to take many pills at once (odds ratio=4.48, p=0.034). Being older was a protector factor of non-adherence (odds ratio=0.81, p=0.034). Conclusion: Adherence among RA elderly patients is optimal and they have good trust in their medication and confidence in their rheumatologist. Older seems wiser when it comes to treatment taking behaviors in RA. References: [1]Hughes LD, Done J, Young A. A 5 item version of the Compliance Questionnaire for Rheumatology (CQR5) successfully identifies low adherence to DMARDs. BMC Musculoskelet Disord 2013; 14: 286. Disclosure of Interests: None declared