Adherence in Young People Living With Juvenile Arthritis: A Systematic Review

Objective: Juvenile idiopathic arthritis (JIA) is one of the leading causes of chronic pain in pediatric patients. Treatment regimens, which are critical to symptom management, can be burdensome, involving medication with potentially aversive side effects and exercise that can cause joint pain. Thus, it is important to examine the barriers and facilitators to adherence in JIA. While systematic reviews exist for rheumatic disease in adults, there has not yet been a synthesis of the literature examining adherence in JIA. Methods: PsychINFO, PubMed, and MEDLINE databases were systematically searched to identify qualitative and quantitative empirical studies that investigate adherence to JIA. Keywords included: "patient compliance" OR "adherence" OR "persistence"; "youth" OR "children" OR "juvenile" OR "pediatric" OR "teen" OR "child" OR "adolescent"; and "rheumatoid arthritis" OR "idiopathic arthritis" OR "arthritis." Articles were excluded from the review if they involved nonhuman or adult samples, were nonexperimental (e.g., practice recommendations), were not peer-reviewed, or were not written in English. After abstract selection, 32 articles were included in the analyses. Results: Adherence to exercise regimens was consistently lower than adherence to medication. Researchers relied heavily on self-report of adherence, which suggests a need for additional research with more objective measures of adherence. Across studies, psychological treatment was not included, so adherence to this treatment component in JIA remains understudied. Conclusions: Results suggest that future research should target devising and evaluating interventions to improve adherence to exercise and perhaps psychological treatment.