Compliance in treatments of rheumatic diseases:: A marathon

Treatments of rheumatic diseases often last over a long period, sometimes as a life accompanying process. A deciding factor for a successful treatment is a favorable cooperation of patients. Treatments include completely different drugs that show a range of side effects and are to be taken in a careful and disciplined manner, requiring a high level of patient information and education. Regularly, physiotherapy, ergotherapy and sometimes psychological interventions are necessary. Patients are expected to cooperate and to take the initiative in physical exercise,joint protection and other therapies. All these requests can lead to an increase of non-compliance. Some studies estimate the part of non-compliance higher than 50% in rheumatic diseases, with tremendous resultant health costs. Therefore improvement in compliance can be an economy reserve in health care together with an improvement in quality of life. Positive and negative influences on compliance are deciphered. A distinction can be made between treatment refusals in general and in particular. A third category of non-compliance includes the modification of drugs deliberately or accidentally. The last category is very important. Drugs are not taken as directed by the doctor but at a higher or a lower dose or at wrong intervals. Consequences are an increase of side effects on the one hand and an increase of disease activity on the other hand. Interventions to influence compliance in a positive direction are presented.