Effects of Adherence to Treatment on Short-Term Outcomes in Children With Juvenile Idiopathic Arthritis DEBBIE EHRMANN FELDMAN, 1 MIRELLA DE CIVITA, 2 PATRICIA L. DOBKIN, 3 PETER N. MALLESON, 4 GARBIS MESHEFEDJIAN, 5 AND CIARA ´ N M. DUFFY 6 Objective. To determine the impact of adherence to treatment (medication and prescribed exercise) on outcomes in children with juvenile idiopathic arthritis (JIA). Methods. In this longitudinal study, we studied parents of patients with JIA at the Montreal Children’s Hospital and British Columbia Children’s Hospital in Vancouver. Adherence was evaluated on a visual analog scale in the Parent Adherence Report Questionnaire. Outcomes of interest were active joint count, pain, child functional score on the Child Health Assessment Questionnaire, quality of life score on the Juvenile Arthritis Quality of Life Questionnaire, and parental global impression of overall well-being. The association between adherence to treatment and subsequent outcomes was evaluated using generalized estimating equations and logistic regression. Results. Mean age and disease duration of our sample of 175 children were 10.2 and 4.1 years, respectively. Moderate adherence to medication was associated with lower active joint count (odds ratio [OR] 0.47, 95% confidence interval [95% CI] 0.22– 0.99). Moderate adherence to exercise was associated with better functional score (OR 0.13, 95% CI 0.03– 0.54), and lower pain during the last week (OR 0.14, 95% CI 0.04 – 0.50). Both high and moderate adherence to exercise were associated with parental perception of global improvement. Conclusion. Improved outcomes in patients who adhered to treatment underscores the need for clinicians to address adherence issues with their patients. Sustaining adherence, particularly to the more time-consuming treatment of exercise, is a challenge. KEY WORDS. Juvenile idiopathic arthritis; Adherence; Health outcomes; Function; Quality of life. INTRODUCTION Juvenile idiopathic arthritis (JIA) is one of the most com- mon chronic medical conditions of childhood and it has potentially serious consequences of joint destruction and disability. More than half of patients with JIA have active disease that persists into adulthood (1,2). In a summary of several studies, Oen concluded that JIA often extends past adolescence into adulthood (3). Guillaume et al (2) studied long-term outcomes in JIA. After 6 years of followup, 50% of patients studied extended to polyarthritis, 35% devel- oped joint erosions, and 30% had uveitis. Most of the complications appeared early in the course of disease, implying that aggressive therapeutic approaches may be Supported by grants from the Canadian Institutes of Health Research (CIHR) and the Canadian Arthritis Net- work. Dr. Ehrmann Feldman is recipient of a new investi- gator award by the Arthritis Society of Canada. Dr. De Civita was supported by the CIHR as a postdoctoral fellow. Dr. Dobkin was supported by the Fonds de la recherche ´ en sante ´ du Que ´bec as a senior career scientist. Dr. Duffy is recipient of the Sessenwein Scholarship Award for Research, Depart- ment of Paediatrics, McGill University. 1 Debbie Ehrmann Feldman, PT, PhD: Universite ´ de Mon- tre ´al, the Montreal Children’s Hospital, and the Public Health Department, Montreal, Quebec, Canada; 2 Mirella De Civita, PhD: Quebec Health Services and Technology As- sessment Agency, Montreal, Quebec, Canada; 3 Patricia L. Dobkin, PhD: McGill University Health Centre, McGill Uni- versity, Montreal, Quebec, Canada; 4 Peter N. Malleson, MBBS, MRCPUK, FRCPC: British Columbia’s Children’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada; 5 Garbis Meshefedjian, PhD: Public Health Department, Montreal, Quebec, Canada; 6 Ciara ´n M. Duffy, MB, BCh, MSc, FRCPC: Montreal Children’s Hospital of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada. Address correspondence to Debbie Ehrmann Feldman, PT, PhD, Universite ´ de Montre ´al, Canada, Faculte ´ de me ´- decine, E ´ cole de Re ´adaptation, CP 6128 Succursale Cen- treville, Montre ´al, Quebec, Canada H3C 3J7. E-mail: debbie.feldman@umontreal.ca. Submitted for publication June 13, 2006; accepted in re- vised form September 18, 2006. Arthritis & Rheumatism (Arthritis Care & Research) Vol. 57, No. 6, August 15, 2007, pp 905–912 DOI 10.1002/art.22907 © 2007, American College of Rheumatology ORIGINAL ARTICLE 905