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Rheumatologists are infamous for prescribing numerous medications. When our patients talk about how doctors in different department are overwhelmed by the loads of medications, we rheumatologists share the same feelings of guilt and indignation. Because of its progression and unique nature, rheumatic diseases, such as rheumatoid arthritis, require multiple drug-regimen rather than single drug regimen, even in the early stages. Hence, initial prescriptions of “strong” medications like immunosuppressant are common practice and important in lieu of treatment guideline. It is not surprising to prescribe more than 6 medications when we rheumatologist add antiinflammatory drugs, heart burn medications, and not to mention rheumatologist’s “favorite” steroids. Moreover, rheumatoid arthritis’ systemic complications like osteoporosis require even more additional prescriptions of calcium and bisophosphonate. Having said that, the rheumatologists are usually perceived as the “blind prescriber,” even when they prescribe something that can alleviate adverse effects like folic acid alleviating the methotrexate adverse effect. Frequently, the total number of medications rheumatologists prescribe exceeds single digit. When patients experience severe pain and totally depend on their physicians, prescribing myriads of drugs poses no problems. Ironically, the real problem arises as the patients' pain is well controlled. Imagine the patients with no apparent symptoms are looking at the pills in their palm. Patients begin to doubt and begin to question their prescriptions. “Will these medications make a nasty stomachache?” “I have heard that steroids are bad.” “Is it really necessary to take these pain killers all at once?” This is exactly when patients' compliance begins to decrease. This is only the start as the real predicament arises. Because of effects of the medication appear slowly over the period of 4-5 months, skipping the drugs for once or twice will not change anything. In fact, forgetting taking medication once or twice will not aggravate any symptoms. However, as the patients habitually skip their medications, the rheumatoid arthritis exacerbations can occur. Doctors who do not recognize this prolonged poor compliance will obviously add more drugs or substitute old prescriptions with newer and stronger medications, thinking that old medications do not work.

the korean journal of internal medicine/korean journal of internal medicine

Can We Calculate Patients' Compliance and Forecast Their Adherence to Medication: Cultural Adaptation of the Korean Version of a Compliance Questionnaire for Patients with Rheumatoid Arthritis