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ORIGINAL ARTICLE • Rev. Bras. Enferm. 78 (3) • 2025 • https://doi.org/10.1590/0034-7167-2024-0436 linkcopy

Impact of pharmacotherapy complexity on self-care in individuals with rheumatoid arthritis

Impacto de la complejidad de la farmacoterapia en el autocuidado de las personas con artritis reumatoide

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives: to analyze the relationship between self-care and pharmacotherapy complexity in individuals with rheumatoid arthritis.

Methods: this cross-sectional study was conducted at a teaching hospital in the Central-West region of Brazil from October to December 2023. Individuals with rheumatoid arthritis undergoing treatment for at least three months were included. A sociodemographic questionnaire, the Appraisal of Self-Care Agency Scale-Revised, and the Pharmacotherapy Complexity Index were used. Analytical statistics were applied using percentiles, the Shapiro-Wilk test, post hoc analysis, ANOVA, and the Kruskal-Wallis test.

Results: the sample consisted of 96 individuals. The mean self-care and pharmacotherapy complexity scores were at intermediate levels, 56.33 and 18.29, respectively. Relationships were identified between dose frequency and self-care development, as well as between overall pharmacotherapy complexity and reduced self-care capacity.

Conclusions: a high dosage frequency may positively influence self-care development in individuals with arthritis, whereas higher pharmacotherapy complexity scores may impair self-care capacity.

Descriptors:
Self Care; Drug Therapy; Arthritis, Rheumatoid; Health Promotion; Self-Management

Sociodemographic Variables	n	%	95% CI
Age group
Under 60 years	47	49.0	39.6 – 59.4
60 years or older	49	51.0	40.6 – 60.4
Sex
Female	85	88.5	81.3 – 94.8
Male	11	11.5	5.2 – 18.8
Race/Ethnicity
Mixed-race	60	62.5	53.1 – 70.8
White	19	19.8	12.5 – 28.1
Black	16	16.7	9.4 – 24.0
Asian	1	1.0	0.0 – 3.1
Marital status
Single	26	27.1	18.8 – 35.4
Married/stable union	44	45.8	36.5 – 56.2
Widowed	13	13.5	7.3 – 20.8
Separated/divorced	13	13.5	7.3 – 20.8
Education level
Illiterate	3	3.1	0.0 – 7.3
Elementary school	57	59.4	50.0 – 68.8
High school	29	30.2	20.8 – 39.6
Higher education	7	7.3	3.1 – 12.5
Religion
None	10	10.4	5.2 – 16.7
Evangelical	43	44.8	34.4 – 55.2
Catholic	37	38.5	29.2 – 50.0
Other	6	6.3	2.1 – 11.5
Employment status
Yes	23	24.0	16.7 – 33.3
No	73	76.0	66.7 – 83.3
Government social benefits*
Yes	67	69.8	60.4 – 79.2
No	29	30.2	20.8 – 39.6
Health insurance
Yes	22	22.9	14.6 – 31.3
No	74	77.1	68.8 – 85.4
Location
Urban	92	95.8	91.7 – 99.0
Rural	4	4.2	1.0 – 8.3
City
Capital	63	65.6	57.3 – 75.0
Countryside	33	34.4	25.0 – 42.7

Clinical and Behavioral Variables	n	%	95% CI
Type of Rheumatoid Arthritis (ICD-10)
Seropositive (M05)	54	56.3	46.9 – 66.7
With involvement of other organs and systems (M05.3)	1	1.0	0.0 – 3.1
Other seropositive rheumatoid arthritis (M05.8)	16	16.7	9.4 – 25.0
Other rheumatoid arthritis (M06)	14	14.6	8.3 – 21.9
Seronegative (M06.0)	2	2.1	0.0 – 5.2
Other specified rheumatoid arthritis (M06.8)	2	2.1	0.0 – 5.2
Unspecified (M06.9)	7	7.3	2.1 – 12.5
Number of comorbidities
0	10	10.4	4.2 – 16.7
1	11	11.5	5.2 – 18.8
2	18	18.8	11.5 – 27.1
3	14	14.6	7.3 – 21.9
4	21	21.9	13.5 – 30.2
5	10	10.4	4.2 – 16.7
6	3	3.1	0.0 – 7.3
7	6	6.3	2.1 – 11.5
8	2	2.1	0.0 – 5.2
10	1	1.0	0.0 – 3.1
Frequent pain
Yes	69	71.9	61.5 – 80.2
No	27	28.1	19.8 – 38.5
Interferes with daily activities
Yes	57	59.4	50.0 – 68.8
No	39	40.6	31.3 – 50.0
Non-pharmacological treatment
Yes	41	42.7	33.3 – 52.1
No	55	57.3	47.9 – 66.7
Psychologist
Yes	6	6.3	2.1 – 11.5
No	90	93.8	88.5 – 97.9
Psychiatrist
Yes	9	9.4	4.2 – 15.6
No	87	90.6	84.4 – 95.8
Cigarette use
Yes	17	17.7	10.4 – 25.0
No	79	82.3	75.0 – 89.6
Alcohol use
Yes	12	12.5	6.3 – 19.8
No	84	87.5	80.2 – 93.8

Variable	Mean	Med.	SD	CV%	Min	Max	P25	p75
ASAS-R Global	56.33	57.0	8.62	15.30	36	75	50.25	62.0
ASAS-R – Factor 1	24.31	24.0	4.44	18.26	8	30	22.0	28.0
ASAS-R – Factor 2	20.54	21.0	3.30	16.06	10	25	18.25	23.0
ASAS-R – Factor 3	11.48	11.0	3.57	31.09	4	20	9.0	14.0
ICFT Global	18.29	16.0	8.75	47.84	2	44	12.0	23.0
ICFT – Factor 1	3.05	3.0	2.28	74.75	1	11	1.0	5.0
ICFT – Factor 2	12.34	12.0	5.98	48.46	1	32	8.0	16.0
ICFT – Factor 3	2.96	2.0	2.98	100.6	0	12	1.0	4.0

ICFT	Low Complexity			Intermediate Complexity			High Complexity
ICFT	n	%	95% CI	n	%	95% CI	n	%	95% CI
Global	29	30.2	21.9 – 39.6	46	47.9	37.5 – 58.3	21	21.9	13.5 – 31.3
Factor 1	46	47.9	38.5 – 58.3	22	22.9	14.6 – 31.3	28	29.2	19.8 – 37.5
Factor 2	26	27.1	18.8 – 36.5	44	45.8	35.4 – 55.2	26	27.1	17.7 – 35.4
Factor 3	30	31.3	21.9 – 41.6	33	34.4	25.0 – 43.8	33	34.4	25.0 – 43.8

ICFT Variables	Self-Care Score (ASAS-R) by Levels of Pharmacological Complexity						p value
	Low		Intermediate		High
	Mean (SD)	Med.	Mean (SD)	Med.	Mean (SD)	Med.
	ASAS-R Global
Global	55.62 (7.88)	57.00	57.09 (9.19)	59.50	55.67 (8.56)	55.00	0.718*
Factor 1	55.78 (9.12)	57.50	55.91 (7.93)	57.00	57.57 (8.47)	58.00	0.669*
Factor 2	55.12 (7.65)	55.00	56.68 (8.83)	57.50	56.96 (9.36)	57.50	0.699*
Factor 3	57.73 (7.99)	59.50	56.64 (9.01)	58.00	54.76 (8.78)	54.00	0.384*
	ASAS-R – Factor 1
Global	24.52 (3.81)	24.00	23.91 (5.13)	24.00	24.90 (3.67)	25.00	0.891**
Factor 1	23.67 (5.19)	24.00	25.05 (3.37)	25.00	24.79 (3.77)	25.50	0.713**
Factor 2	24.27 (3.96)	24.00	24.14 (4.47)	24.00	24.65 (4.97)	26.00	0.663**
Factor 3	25.47 (3.68)	26.50	24.33 (4.53)	25.00	23.24 (4.82)	24.00	0.167**
	ASAS-R – Factor 2
Global	19.69 (3.54)	20.00	20.96 (2.78)	20.50	20.81 (3.92)	21.00	0.247**
Factor 1	20.26 (3.29)	20.00	20.41 (3.34)	21.00	21.11 (3.34)	22.00	0.462**
Factor 2	19.73 (2.76)	19.50	20.41 (3.49)	20.50	21.58 (3.32)	21.50	0.048**
Factor 3	20.17 (3.45)	20.00	20.82 (3.16)	21.00	20.61 (3.37)	21.00	0.731**
	ASAS-R – Factor 3
Global	11.41 (2.59)	11.00	12.22 (3.88)	12.00	9.95 (3.68)	9.00	0.015**
Factor 1	11.85 (3.26)	12.00	10.45 (3.55)	10.00	11.68 (4.02)	11.00	0.307*
Factor 2	11.12 (3.05)	10.00	12.14 (3.72)	12.00	10.73 (3.73)	10.50	0.237*
Factor 3	12.10 (3.43)	12.00	11.48 (3.65)	11.00	10.91 (3.63)	10.00	0.422*

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