Avaliação do conhecimento sobre metotrexato e da adesão ao tratamento em pacientes ambulatoriais com artrite reumatóide: das análises e correlações a uma estratégia educativa

Abstract

Rheumatoid arthritis (RA) is a chronic inflammatory disease that can affect extra-articular joints. The prevalence of RA in Brazil ranges from 0.2% to 1% and is three times more prevalent in middle-aged women. The objective of this study was to analyze knowledge about methotrexate (MTX) and medication adherence in RA. This was a cross-sectional and prospective study with collection of sociodemographic and clinical data, adherence to rheumatoid arthritis treatment using the Brazilian version of the Compliance Questionnaire Rheumatology (bCQR) and assessment of knowledge about MTX with the Methotrexate Questionnaire (bMTXQ). The sample consisted of 69 patients, with a mean age of 55.11 years and a predominance of females (95.65%). Most participants had been diagnosed with RA for ten years or more (49.28%) and had a family history of the disease (65.22%). Systemic arterial hypertension (47.83%) and diabetes mellitus (27.54%) were the most prevalent comorbidities. The analysis of adherence revealed that 62.3% of patients presented satisfactory adherence, while 37.7% were classified as having unsatisfactory adherence. The knowledge assessment showed that only 18.84% of participants answered all the essential questions for the safe use of the medication correctly. Critical items presented low accuracy rates, such as interaction with trimethoprim (23.99%), hematologic risk (28.99%) and maximum recommended weekly dose (44.93%). The analysis identified a significant association between essential knowledge about MTX and adherence to treatment (p=0.013). Patients with better knowledge demonstrated greater adherence to therapy. In addition, the presence of caregivers was associated with a higher level of knowledge about MTX (p=0.027), suggesting the positive impact of support on therapeutic management. However, the correlation between knowledge and adherence, although positive, was considered weak (r=0.210; p=0.084), indicating the influence of other factors on adherence. The correlation between knowledge about methotrexate and patient adherence to therapy showed that the level of adherence was more satisfactory when the results of knowledge about methotrexate were also higher, which corroborates data from the literature that knowledge about the treatment, such as its risks and benefits, can increase adherence and obtain better results in therapy. The literature reinforces that educational actions improve adherence and reduce the risk of treatment discontinuation. Thus, this study highlights the need for continuous, personalized and accessible educational interventions to optimize the management of RA and the safety of MTX use.