Determinants of Medication and Exercise Adherence in Patients with Rheumatoid Arthritis: A Cross-Sectional Study in a Tertiary Rehabilitation Center

Objective Medication and exercise adherence are critical yet frequently underrecognized aspects of rheumatoid arthritis (RA) management. Recent literature has highlighted the need for further investigation in this area. This study aimed to evaluate medication adherence and associated factors in patients with RA and to assess adherence to prescribed home exercise programs as a component of nonpharmacological treatment. Methods This cross-sectional study included 125 RA patients (mean age: 56.5±11.4 years) recruited between February 2024 and July 2025. Medication adherence was assessed using the Medical Adherence Report Scale (MARS) and the Morisky Medication Adherence Scale (MMAS), while exercise adherence was evaluated with the Exercise Adherence Rating Scale (EARS). Clinical, functional, and psychological variables were analyzed using correlation and regression analyses. Results High medication adherence was observed in 79% of patients based on MARS and 64% based on MMAS. Depressive symptoms (BDI≥17) were present in 30%, and HAQ scores indicated moderate disability. Regression analysis demonstrated that higher pain levels, greater fatigue, increased disability, and the presence of active arthritis were independently associated with lower medication adherence (p<0.05). Only 10% had a prescribed home exercise program, and adherence to these programs, as measured by EARS, was low. No significant associations were found between exercise adherence and clinical or demographic factors. Conclusions Fatigue, functional limitation, and active arthritis are major barriers to medication adherence in RA. Despite the recognized benefits of exercise therapy as an integral component of nonpharmacologic treatment, its low prescription and adherence rates highlight the need for greater emphasis on nonpharmacologic strategies in RA management.