The development of a positive self-concept and body image in adolescents with chronic rheumatic diseases is challenged by the experience of side effects of the medications. NSAIDs and DMARDs are associated with a number of adverse effects, of which gastrointestinal complaints (e.g., nausea, vomiting, diarrhoea, dyspepsia) are most common. Pseudoporphyria or linear facial scarring was estimated to affect 11% of children taking chronic NSAIDs (68). Hepatotoxicity, bone marrow suppression, lung disease, rash, fever may also occur (21). The cosmetic side effects may be particularly troublesome for adolescents and may often lead to poor adherence with medication taking (1).
Polypharmacy may also be a reason for nonadherence. Patients are expected to take not only the agents themselves but also additional therapy such as folic acid and/or calcium supplements to offset medication-related adverse events (16).
Other examples of treatment-related risk factors of poor adherence include longer duration of treatment regimen, complexity of regimen (e.g., taking multiple medications at different times throughout the day, exercising several times a week), and unstable efficacy of treatment (69).
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