• Studies show that between 35 percent to 85 percent of people with rheumatoid arthritis (RA) do not take their medication as prescribed.
• People with RA may stop treatment because of cost, adverse side effects, or discomfort with taking medication.
• To feel your best and stay healthy, it’s important to address any obstacles in your way and continue on your RA treatment plan.

Sticking to your RA treatment plan means taking medication exactly as your doctor prescribes it, on schedule. Disease-modifying antirheumatic drugs (DMARDs) are prescribed to treat RA and other inflammatory diseases.¹ They have been shown to reduce disease activity, slow disease progression, relieve joint pain, and may help prevent long-lasting damage and complications. However, it is sometimes difficult to stay on DMARD treatment.

Studies show that between 35 percent to 85 percent of individuals with RA do not take their medication according to their health care provider’s instructions.² One study from Rheumatology and Therapy found that around one-third of participants in the study stopped their treatment within the first year, and almost half stopped within two years.³

There are many reasons why people with RA stop taking DMARDs. Fortunately, there are resources that can help you stick to your treatment plan. Here are some of the most common obstacles to sticking with RA treatment, along with tips on how to overcome them.

1. Get Help Paying for Medication

According to health economist Austin Frakt, Ph.D., the cost of medications for treating RA is the number one reason people do not stick with their treatment plans.⁴

A variety of assistance programs are available to help people obtain and pay for medications.⁵ If you need help in this area, talk to your health care team for specific resources in your area. The Arthritis Foundation has compiled a list of specific questions to ask your rheumatologist, their billing manager, and the pharmacist to help you get the lowest costs on your care.⁶

There are also nonprofit organizations with patient assistance programs providing financial assistance to those in need. These include:

• The Assistance Fund⁷
• Medicine Assistance Tool⁸
• National Council on Aging's Benefits Checkup⁹
• Patient Access Network (PAN) Foundation¹⁰
• Patient Advocate Foundation¹¹

2. Make Taking Medication Easier

Taking medication for RA can be overwhelming, especially if you take multiple medications. However, it is important to stick with your treatment plan to help prevent other complications from developing later on.²

DMARDs are available in several forms, including oral, self-injectable, or intravenous, depending on the drug you take. Conventional DMARDs and targeted DMARDs are available as pills that are taken by mouth. Biologic DMARDs are taken by injection or intravenously.

Tips for Taking Injected Medication

Some biologic DMARDs are administered as self-injectables. Self-injectable medications are taken at home using a pen, prefilled syringe, or electronic auto-injector device. Self-injection may be preferable over receiving injections at the doctor’s office, but it can take time and practice to get used to. Your rheumatologist or nurse will train you to properly inject and will answer any questions you have.

Here are some tips for self-injections:¹²

• Choose the right injection site. This could be the abdomen, arms, or thighs depending on the medication. Be sure to rotate locations to prevent pain and scarring.
• Ice the injection site before and after administering medication if appropriate. Pinching the skin during the injection can help minimize discomfort as well.
• Ask your doctor whether an over-the-counter topical numbing medication might be safe to use on the skin before injecting.
• Allow medications to come to room temperature before injecting — cold medications can be uncomfortable. Be sure to ask your doctor about the ideal temperature for your medication.
• Count down out loud to prepare yourself for the injection.
• Treat yourself to a small reward after the injection, like your favorite snack.

Tips for Taking Oral Medication

Conventional and targeted DMARDs are often available in pill form to take by mouth. Here are some tips to make taking oral medications easier:

• Note whether the package instructions say to take the medication with or without food,¹³ and take it exactly as directed.
• Do not crush or chew certain oral medications, since this can affect how they’re absorbed.¹⁴
• Use a pill container that sections out doses to help keep you on schedule, depending on storage requirements of the medication.¹⁵

Tips for Staying on Schedule With Medications

Living with RA can mean taking several medications to manage the disease and keeping track of multiple medications can be difficult.⁴ Taking certain medications at the same time every day or along with daily tasks (for instance, brushing your teeth) can help create a routine that is easy to remember over time. If you tend to forget, set an alarm or download an app for your phone that sends medication reminders.

3. Manage the Side Effects of Treatment

Every medication can cause side effects, even familiar over-the-counter medications. Some people experience side effects with DMARDs for RA that can be challenging, making it hard to stay motivated to stick with treatment.¹⁶ Report all side effects you experience to your doctor. They may decide to switch medication or may have other recommendations that help you better manage side effects and make DMARDs more tolerable.

The goal of treatment is to improve the symptoms of RA while balancing the risks of unwanted side effects. It is important to speak with your rheumatologist if side effects occur. To ensure that you have a record of any side effects, consider keeping a journal where you track them so you can discuss them in detail with your health care team.

Read more about the benefits of sticking with RA treatment.

Ask your doctor for safe ways to potentially reduce the side effects of DMARDs. Depending on the specific medication, these may include eating a snack or meal before taking your medication or such strategies as taking folic acid if you are on methotrexate, which can help with gastrointestinal issues, hair loss, and fatigue.¹⁷ Your health care team will help advise you on what might work to help you alleviate side effects.

If you find you are having difficulty tolerating the side effects of your treatment, or you are not able to meet your treatment goals, then be sure to speak to your rheumatologist. It may be time for a shared decision to change to a different medication.

4. Be Open With Your Rheumatologist

Some people stop taking their DMARDs because they do not see an improvement in their symptoms.² However, RA is a lifelong, chronic condition that needs to be continuously managed.

On the other hand, DMARDs may work so well in some people that they want to wean off of them when they feel better. This can be dangerous. For example, about half of people who stop biologic DMARDs will have flare-ups in their RA (a relapse of their symptoms).² Likewise, when people with low disease activity stop taking a conventional DMARD, about half experience flare-ups within six months.¹⁸

If you are worried about the effectiveness of your medication, or if you are feeling better and wondering if you really need your DMARD, talk to your doctor rather than simply stopping treatment.

Sticking with your RA treatment plan may help to avoid flare-ups and may keep RA under control. If you have concerns about sticking with your RA treatment plan, be frank with your rheumatologist and collaborate closely on other treatment options. In the process of shared decision-making, you and your doctor discuss your goals and preferences and the risks and benefits of each treatment option.

Read more about shared decision-making.

Talk With Others Who Understand

On myRAteam, the social network for people with rheumatoid arthritis and their loved ones, more than 171,000 members come together to ask questions, give advice, and share their stories with others who understand life with RA.

Are you struggling to stick to your RA treatment? Have you found any tips or tricks to stick with your treatment plan? Share your thoughts and experience in the comments below, or start a conversation by posting on myRAteam.