[Nonadherence and ineffective methotrexate treatment of inflammatory arthritis]

Failure to comply with treatment recommendations in chronic diseases, including inflammatory arthritis, is one of the main reasons why patients do not achieve health benefits. It is widely recognized that effective pharmacotherapy requires a conviction to undertake and continue. In case of methotrexate therapy failure, it is necessary to consider the possibility and cause for non adherence to treatment. In order to achieve chosen therapy goals, cooperation of patient and physician is essential. A review of medical literature brings up a necessity to consider the differences in understanding and definition of both compliance and adherence, and whether the failure in treatment is tied to pharmacology, or inadequate patient knowledge. Patient education should entail thorough understanding of therapy goals, the mainstay role of methotrexate in current strategies and the benefits of consistent treatment. Attention should be paid to the role of methotrexate polyglutamates in monitoring therapy effectiveness, and the choice between subcutaneous and oral administration. A joint consideration of the dosing regimen, convenient methods of administration and dispelling any doubts over adverse events are milestones that will translate into better adherence.