Psycho-cognitive factors and adherence to disease-modifying biologic therapies in patients with rheumatoid arthritis: A cross-sectional study

Introduction: Therapeutic adherence with biologic therapies is crucial for optimal treatment outcomes in rheumatoid arthritis (RA). Materials and Methods: This single-center, cross-sectional study aimed to assess biotherapy adherence in Moroccan RA patients and investigate its relationship with psycho-cognitive factors, including depression, anxiety, pain catastrophizing, and fibromyalgia. We evaluated 67 RA patients at Ayachi University Hospital – Salé, using the Girerd questionnaire for medication adherence, a French adaptation of the 6-item MMAS (Morisky Medication Adherence Scale), the Hospital Anxiety and Depression Scale (HAD) Pain Catastrophizing Scale (PCS), and Fibromyalgia Rapid Screening Tool (FIRST). Results: The sample population was predominantly female (92.5%), with a mean age of 55.5 years ± 13.7 years. Most patients received Rituximab (52.2%), followed by anti-TNF drugs (35.9%) and anti-IL6 drugs (11.9%). Results revealed poor adherence in 71.6% of patients, with a high prevalence of psychological comorbidities: anxiety (100%), depression (98.5%), pain catastrophizing (53.7%), and fibromyalgia (19.4%). In univariate analysis, poorer adherence was associated with a higher Health Assessment Questionnaire (HAQ) score (OR = 0.24; 95% CI [0.09 – 0.64]; p = 0.004) and a longer history of RA (OR = 0.92; 95% CI [0.85 – 0.99]; p = 0.043). Multi-medicated patients had poorer adherence (OR = 3.12; 95% CI [1.03 - 9.42]; p = 0.043), as did those with pain catastrophizing (OR = 3.61; 95% CI [1.16 - 11.18]; p = 0.02). Surprisingly, anxiety, depression, and fibromyalgia did not significantly affect adherence. Conclusion: This study reported a low rate of adherence to biotherapy (28.4%) in Moroccan RA patients, with key factors such as disease duration, HAQ index, polypharmacy and pain catastrophizing significantly affecting adherence. These findings highlight the need for tailored therapeutic education and management strategies to improve biotherapy adherence in RA patients.