Disease-modifying antirheumatic drugs (DMARDs) are a group of medications which slows the progression rate of rheumatoid arthritis (RA), prevents joint damage and decreases pain and inflammation. Although non-adherence to DMARDs is fairly common, many reviews have revealed that 49%-99% of patients suffering from RA are adherent based on the measurement method of adherence. Non-adherence leads to adverse events and further aggravates the treatment course.

Candace H Feldman et al. Investigated whether patient navigators (laypersons trained in care coordination, motivational interviewing, basic pharmacology, and disease management) ameliorated oral DMARD adherence.

Total 107 patients aged ≥18 years with systemic rheumatic diseases who initiated an oral DMARD within 6 months were enrolled for the study. For 6 months, the navigators interacted with these patients up to 2-4 times/ week. At baseline and 6 months, the patients finished the validated surveys (Morisky Medication Adherence Scale [MMAS-8], Mental Health Inventory [MHI-5], Beliefs about Medicines Questionnaire, and Brief Illness Perception Questionnaire). The outcomes were compared using the paired t-tests. Multivariable linear regression was used to examine the relationship of age, race/ethnicity, insurance, and MHI-5 with a change in MMAS-8 score.

Overall, 69 (64%) completed baseline and 6-month MMAS-8 surveys among the 107 patients. The mean± SD age was 55 ± 16 years with 93% being females. Borderline adherence was revealed as the mean ± SD baseline MMAS-8 score was 6.7 ± 1.3 and <68 suggested the presence of any depressive symptoms as the mean ± SD MHI-5 score was 60.8 ± 9.1. No notable changes were seen in MMAS-8 or MHI-5 after 6 months. The patients explained fewer medication concerns, but a more threatening perception of illness. For each 5-year increase in age, the multivariable model portrayed a minor change in MMAS-8. 

Thus, it was found that there was no change in adherence from baseline. There is a need for a multicenter, randomized controlled trial to reveal whether patient navigators are useful in maintaining adherence to DMARDs over time.