Poor adherence with pharmacological and non-pharmacological treatments is a widespread problem in adolescents with chronic rheumatic diseases, which may result in poor clinical outcome and increased health care costs (Table 3). The detection of poor adherence should be a permanent concern of health care teams dealing with adolescents with JIA. However, research on prevalence, risk factors, and adherence-enhancing interventions in this patient population is scarce. Prospective studies are needed to identify adolescents and families at risk for adherence problems (17). Qualitative research to provide insight in the barriers and facilitators of poor adherence is also needed. Further research is needed to work out the pattern of causal relationships between adherence and clinical outcomes. Finally, the

Table 3 Key Learning Points

Adolescents with chronic rheumatic diseases show poor adherence in pharmacological and non-pharmacological therapies. Poor adherence is a major cause of suboptimal clinical outcome and may have negative implications for well-being in adulthood. Poor adherence can be intentional and involuntary. The determinants of adherence are multifactorial and relate to adolescents' socioeconomic status, psychosocial characteristics, condition, treatment, and the health care system. Interventions to promote adherence are similarly multifactorial and include education, family support, cognitive-behavioral modifications, and provider characteristics (e.g., adolescent-focused care, improved communication, shared decision-making). The quality of the therapeutic relationship is an important determinant of adherence, and all health professionals can promote adherence. There is a dearth of literature concerning the adherence of adolescents with chronic rheumatic diseases, and changing this must be made a priority to improve outcome.

effectiveness of adherence-enhancing interventions should be tested in randomized controlled clinical trials.

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