Medication Beliefs Linked to Adherence in Primary Sjögren Disease
Key Takeaways
- In a tertiary rheumatology cohort from Türkiye, 40% of reassessed patients with newly diagnosed primary Sjögren disease were classified as low adherence during follow-up.
- Baseline sociodemographic and clinical characteristics did not distinguish patients with low adherence from those with high adherence.
- Disease activity, Sjögren symptom burden, fatigue, psychological symptoms, function, and health-related quality of life were broadly similar across adherence categories over time.
- The necessity-concern differential was significantly lower in patients with low adherence, and higher differential values were associated with high adherence in exploratory analysis.
In a prospective cohort in newly diagnosed primary Sjögren disease, investigators enrolled consecutive adults in a tertiary rheumatology outpatient clinic in Türkiye; all met American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria. The cohort included 54 patients, and 40 of 54 were reassessed after a mean follow-up of 21.36 ± 4.79 months. Adherence was measured at follow-up with the 5-item Compliance Questionnaire for Rheumatology (CQR-5), while disease activity and patient-reported outcomes were collected at baseline and follow-up with the EULAR Sjögren’s Syndrome Disease Activity Index (ESSDAI), EULAR Sjögren’s Syndrome Patient Reported Index (ESSPRI), Hospital Anxiety and Depression Scale (HADS), fatigue severity assessment, Health Assessment Questionnaire (HAQ), and 12-item Short Form Health Survey (SF-12). Beliefs about medicines were assessed at follow-up with the Beliefs about Medicines Questionnaire (BMQ), which provided the necessity-concern differential, and logistic regression was restricted to exploratory analysis because of the small sample and event count.
At follow-up, 16 of 40 reassessed patients were classified as low adherence and 24 of 40 as high adherence. Baseline age, body mass index, symptom duration, sex distribution, employment, smoking, education, and broader clinical characteristics did not differ significantly between groups. ESSDAI remained low and stable, and ESSPRI rose modestly in both groups without significant between-group differences in change scores.
Psychological symptoms, fatigue, functional status, and SF-12 scores were also similar across adherence categories at baseline, follow-up, and longitudinal comparisons. Medication beliefs showed a different pattern: necessity scores trended higher in the high-adherence group and concern scores trended higher in the low-adherence group, but only the necessity-concern differential findings in primary Sjögren disease separated the groups significantly, at -0.43 ± 1.16 in low adherence versus 0.30 ± 0.96 in high adherence; p=0.038. In exploratory regression, each one-point increase in the differential was associated with higher odds of high adherence (OR 1.95, 95% CI 1.01-3.76).
Adherence and medication beliefs were measured at the same follow-up time point, so the association was cross-sectional and does not establish a temporal or causal sequence. The CQR-5 is a self-report tool whose performance has not been specifically established in primary Sjögren disease, and detailed medication regimens, treatment changes, and adverse effects were not systematically collected, limiting regimen-level interpretation. The small, single-center cohort in Türkiye and its predominantly female makeup further narrow generalizability. Within those bounds, the authors interpreted perceptual factors as appearing more closely tied to adherence classification than measured disease burden in this cohort.
Low medication adherence was frequent during follow-up in newly diagnosed primary Sjögren disease in this tertiary cohort from Türkiye. Disease activity and patient-reported burden did not clearly distinguish adherence groups, and the lower necessity-concern differential linked to low adherence remained an exploratory, non-causal finding.
Clinician Questions
How was medication adherence defined in newly diagnosed primary Sjögren disease?
Investigators assessed adherence at the follow-up visit with the 5-item Compliance Questionnaire for Rheumatology (CQR-5) and categorized patients into low- and high-adherence groups using recommended scoring procedures. Because the measure was self-reported and had not been specifically validated in primary Sjögren disease, those categories should be interpreted cautiously.
When were medication beliefs measured relative to adherence in primary Sjögren disease?
Medication beliefs were measured at the same follow-up time point as adherence with the Beliefs about Medicines Questionnaire (BMQ), and the necessity-concern differential was calculated as necessity score minus concern score. That timing makes the observed relationship between beliefs and adherence cross-sectional rather than temporal or causal.
Which patients with primary Sjögren disease do these findings most directly apply to?
These findings most directly apply to consecutive adults aged 18-65 years with newly diagnosed primary Sjögren disease in a single tertiary rheumatology outpatient clinic in Türkiye, all meeting 2016 American College of Rheumatology/European Alliance of Associations for Rheumatology (ACR/EULAR) classification criteria; however, “newly diagnosed” referred to time of diagnosis rather than symptom onset, and some patients may have had a longer prediagnostic disease course. The cohort was predominantly female and managed in routine practice, which helps bound generalizability.
Recommended Reading
- For more on Sjögren’s disease and emerging therapies: Sjögren’s Myth Busters: Can You Detect Fact from Fiction on Emerging Therapies?