Adherencia al tratamiento en pacientes con lupus eritematoso sistémico

espanolAntecedentes y objetivo El incumplimiento terapeutico constituye un importante problema asistencial en pacientes con lupus eritematoso sistemico (LES). Conocer los factores asociados de este puede ser de gran utilidad en el ambito clinico. El objetivo de esta investigacion fue analizar la influencia de las variables sociodemograficas, clinicas y psicologicas sobre la adherencia al tratamiento en una muestra espanola de mujeres con LES. Pacientes y metodo En este estudio transversal-observacional se evaluo el grado de adherencia al tratamiento, el estado clinico y psicopatologico, el estres psicologico y la autoeficacia en mujeres con LES. La muestra se dividio en 2 grupos: adherentes y no adherentes. Mediante un analisis de regresion logistica se identificaron los factores asociados a la falta de adherencia en esta poblacion. Resultados Se evaluaron 72 pacientes (edad media: 36,7±12,2 anos). El 63,9% no tuvieron adherencia. Un bajo nivel educativo, estar desempleada, vivir en pareja y el consumo de alcohol se asociaron a una baja adhesion al tratamiento. Se encontraron diferencias entre el grupo adherente y el no adherente en las subescalas psicopatologicas de somatizacion, obsesion-compulsion e indices psicopatologicos generales, asi como en el estres percibido, obteniendo puntuaciones mas altas las pacientes adherentes. El uso de antiinflamatorios no esteroideos (AINE), tener artrosis y mayor alteracion psicopatologica fueron predictores significativos de la adherencia al tratamiento, explicando entre el 35 y el 47% de la variabilidad de esta. Conclusiones La falta de adherencia al tratamiento de las pacientes con LES fue alta y parece estar influida por factores clinicos y psicopatologicos. EnglishBackground and objective Non-adherence to treatment is usually a clinical problem in patients with systemic lupus erythematosus (SLE). Increasing the knowledge of predictors of treatment adherence can be meaningful in the clinical setting. The main objective of the present study was to analyse the influence of sociodemographic, clinical and psychological variables on the degree of treatment adherence in a sample of Spanish women with SLE. Patients and method This is an observational-transversal study. All participants were evaluated for the degree of treatment adherence, their clinical status, psychopathological manifestations, the level of perceived stress and self-efficacy. The sample was divided into two groups (adherent vs non-adherent). The factors associated with a lack of adherence in this sample were analysed by means of logistic regression. Results This study comprises 72 women with SLE (average age=36.72±12.2 years). Almost 64% of patients with SLE were non-adherent to treatment. The results showed that a low educational level, being unemployed, living with a partner and alcohol abuse were associated with low treatment adherence. There were significant mean differences between groups in psychopathological subscales of somatisation, obsession-compulsion and general psychopathological indices. There were also mean differences between groups for the level of perceived stress. The use of non-steroidal anti-inflammatory drugs, suffering arthrosis and scoring higher in dimensions of psychopathology were significant predictors of treatment adherence, explaining between 35% and 47% of its variability. Conclusions Including the clinical and psychopathological manifestations as important aspects in the clinical reasoning of health professionals could improve the adherence to treatment of patients with SLE.