Medication adherence in rheumatoid arthritis: implications for cardiovascular disease risk and strategies to address in U.S. veterans

Introduction: Rheumatoid arthritis (RA) is a systemic inflammatory disease associated with an increased risk of cardiovascular disease (CVD) and premature mortality. The risk of CVD is closely associated with RA disease activity, and achieving RA remission using disease-modifying anti-rheumatic drugs (DMARDs) can significantly mitigate this risk. However, despite the availability of highly effective DMARDs, many veterans fail to achieve sustained RA remission.

Areas covered: We will discuss DMARD adherence in U.S. veterans with RA as it relates to RA disease activity and CVD risk, describe factors associated with DMARD non-adherence in individuals with RA, and discuss intervention strategies to improve DMARD adherence. For this review, the authors performed an extensive literature search using Embase, PubMed, Google Scholar, MEDLINE, Cochrane Library, Web of Science, and Duke University library resources.

Expert opinion: Barriers to DMARD adherence in veterans with RA are multifactorial and include patient-related factors, systemic barriers, and suboptimal adherence screening practices. Additional research is needed to create validated screening tools for DMARD adherence, train rheumatology providers on how to assess DMARD adherence, develop effective interventions to promote veteran self-efficacy in DMARD management, and to learn how to sustainably utilize multidisciplinary resources to support DMARD adherence in veterans with RA.