Mobile Phone Text Messages and Effect on Treatment Adherence in Patients Taking Methotrexate for Rheumatoid Arthritis: A Randomized Pilot Study

Objective To assess the impact of weekly text messages on adherence in patients taking methotrexate ( MTX ) for rheumatoid arthritis ( RA ). Methods This prospective, randomized pilot, single‐site study included patients with RA stabilized using MTX alone or combined with biologics. Participants were randomized to 3 interventions: a standard consultation (controls), a 15‐minute pharmacist‐led counseling session, or the receipt of text message reminders. The change over time in the Compliance Questionnaire Rheumatology ( CQR ‐19) score between baseline and 6 months was defined as the primary outcome for adherence. Multivariable analyses and final adherence (as a composite outcome of the CQR ‐19 score, the Girerd score, and the medication possession ratio) were probed in sensitivity tests. Rheumatologic scales, inflammation, and patient satisfaction were also analyzed. Results A total of 96 patients (mean ± SD Disease Activity Score in 28 joints 2.42 ± 1.03) were monitored. The change over time in the CQR ‐19 score was significantly higher in the text message group (mean ± SD 3.32 ± 5.66; P = 0.02) than in the control group (mean ± SD 0.22 ± 6.56) and the pharmacist‐led counseling group (mean ± SD −0.14 ± 7.56). Multivariable logistic regression showed that text messages remained associated with an increase in the CQR ‐19 score, independently of the baseline CQR ‐19 score (odds ratio 3.63 [95% confidence interval 1.26–10.49]; P = 0.017). In the text message group, the increase in the CQR ‐19 score was correlated with the Health Assessment Questionnaire score (r = −0.405, P = 0.021), and patient satisfaction was significantly higher ( P < 0.01) than in the control group. Conclusion Our results showed evidence of a positive impact of text messages on adherence to MTX treatment for RA . The clinical benefit and the ideal target patient remain to be determined.