Factors affecting adherence to treatment in patients with familial mediterranean fever

Introduction-Aim: Familial Mediterranean Fever(FMF) is an autosomal recessive autoinflammatory disease characterized by recurrent episodes of fever and serositis. The disease is caused by mutation of the Mediterranean Fever gene(MEFV) on the short arm of chromosome 16, which encodes the anti-inflammatory protein pyrin. Complications may occur in many tissues and organs; especially the kidneys, due to recurrent inflammatory processes in patients. Treatment compliance of patients plays an important role in reducing the number of attacks, improving quality of life and preventing disease-related complications. In this study, we aimed to contribute to the literature by investigating the treatment habits of patients and the factors affecting their compliance to treatment. Material-Method: In our study,94 FMF patients aged 16 years and older who were admitted to Çukurova University Faculty of Medicine, Rheumatology Clinic between January 2014 and August 2024 and who had been receiving regular colchicine treatment for at least six months were included. Some patients were contacted face-to-face during outpatient clinic application and some patients were contacted via telephone numbers obtained from the hospital data processing unit and a questionnaire study was conducted by filling out an informed consent form. Results: The male/female ratio was 1,29/1 and the mean age was 35,6±14,9 (Med: 30) years. 61.7% of the patients had an additional chronic disease, 56,4% used regular additional medication and 41,5% had FMF-related tissue or organ complications. The mean age at the onset of the first FMF complaint was 14,2±12,3 (Med: 9,5) years; the mean age at diagnosis was 21,9±15,1 (Med: 19) years;and the mean delay in diagnosis (years) was 8,83±10,4 (Med: 5). 95,7% of the patients were on domestic colchicine, 23,7% on international colchicine, 7,4% on anakinra and 12,8% on canakinumab. The mean score of the Morisky Treatment Compliance Scale was 4,59±2,3 (Med:4); 13 (13,8%) patients had high compliance, 26 (27,7%) had moderate compliance and 55 (58,5%) had low compliance. The mean score of PRAS Disease Severity Scale was 7,54±2,4 (Med: 7.5); 23 (24,5%) of the patients had mild disease, 61 (64,9%) had moderate disease and 10 (10,6%) had severe disease. The mean age at diagnosis and age at treatment initiation were higher in patients with moderate and high compliance than in patients with low compliance (p=0,044; p=0,024, respectively). Patients with moderate and high adherence had a lower rate of myalgia than patients with low adherence (p=0,046). Patients with moderate and high adherence had lower rates of side effects of colchicine and discontinuation of colchicine for any reason (p=0,045; p=0,007, respectively). Patients with moderate and high adherence had lower rates of forgetting medication (p<0,001) and higher rates of hospitalization and non-compliance in outpatient follow-up (p=0,028; p=0,026, respectively) compared to patients with low adherence. Discussion: In our study, there was no statistically significant difference in the compliance groups except for age. The most important factors in treatment adherence were found to be the age of the disease and the age of initiation of treatment. We found that factors such as accessibility to the physician, psychological status, economic factors and family problems had no effect on treatment adherence. Keywords: Familial Mediterranean Fever, treatment adherence, colchicine