Poor adherence was found to be associated with longer duration of disease (23). Moreover, patients with high disease activity tend to be more adherent with treatment advice than those with low disease activity (66,67). The perception of being in good condition, which is the ultimate goal of rheumatological treatment, may involve a dangerous pitfall, as patients are less likely to take their medications, exercise or wear their splints on a routine basis if they perceive themselves as healthy. Patients' fearful of acute problems were also more likely to be adherent compared to teenagers showing no fear (53).
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