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To the Editor: We read with interest the study by Harrold, et al exploring cost-related medication nonadherence (CRN) in elderly American patients with rheumatoid arthritis (RA)1. In their study of a population covered by insurance, Harrold, et al have identified cost as the reason for medication nonadherence. However, nonadherence to medication and followup in RA is a complex issue, with several patient-specific and disease-specific domains. Factors such as beliefs about medication, which have social and psychological roots, have an important influence on adherence2. The traditional paternalistic view that the patient is a passive party who should take their prescribed medications and adhere to the recommended followup is also a major barrier3. In contrast to industrialized nations, in a developing and populous country such as India an additional barrier could be the lack of awareness regarding RA and the benefits of managing it, which go beyond mere symptom alleviation. It is noteworthy that healthcare in India is by … Address correspondence to Dr. V. Ravindran, MES Medical College, Perinthalmanna-679338, Kerala, India. E-mail: drvinod12{at}gmail.com

The Effect of Rheumatoid Arthritis Disease Education on Adherence to Medications and Followup in Kerala, India