Investigating adherence to methotrexate in patients with rheumatoid arthritis

Student thesis: Phd


Background: Methotrexate (MTX) is the first-line treatment for rheumatoid arthritis (RA), yet response is not universal and patient non-adherence may partially explain this. Given that achieving remission remains a priority for rheumatologists, very little is known about their views and clinical approach when prescribing MTX. Aims: The aims of the Thesis were; 1) to quantify the rate of adherence to MTX in the UK, 2) to identify the reasons for non-adherence and 3) to investigate the predictors of non-adherence; from the patient and rheumatologist perspectives. Methods: The Rheumatoid Arthritis Medication Study is a prospective cohort of patients with RA who are incident MTX users, followed over their first year of MTX therapy. MTX adherence and reasons for non-adherence were quantified utilising patient diaries that captured weekly MTX use from baseline to six months. The multivariable effects of baseline characteristics on the odds of being ever non-adherent at six months were calculated. In a subsample, positive, negative and uncertain illness appraisals were coded from free text contained in patient diaries. The MTX related appraisals made during therapy of adherent and non-adherent (100% versus
Date of Award1 Aug 2018
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorLis Cordingley (Supervisor), Kimme Hyrich (Supervisor) & Suzanne Verstappen (Supervisor)


  • Methotrexate
  • Shared decision making
  • Clinical practice
  • Clinician beliefs
  • Illness beliefs
  • Mixed methods
  • Patients
  • Anti-rheumatic medication
  • Arthritis
  • Adherence
  • Health beliefs

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