People with rheumatoid arthritis who carry more comorbidities, report stronger pain, have less formal education, or take combination drug therapy tend to face more complex medication regimens, according to a cross-sectional study conducted at a teaching hospital in central-western Brazil between October and December 2023.
Ninety-six individuals with rheumatoid arthritis were included in the sample. Complexity levels were segmented into low, intermediate, and high for comparison, and most participants fell into the intermediate category.
The study population had a mean age of 59.6 years with a standard deviation of 10.3 years, and women predominated across all complexity levels. Participants completed a sociodemographic and health questionnaire alongside the MRCI assessment, allowing the researchers to relate regimen complexity to demographic and clinical characteristics.
In the initial bivariate analysis, female sex and the absence of a spouse appeared to be associated with greater pharmacotherapeutic complexity. However, these associations did not remain statistically significant once the analysis moved to a multivariable model, suggesting that other measured factors better explained the variation in regimen complexity.
The multivariable linear regression model, which achieved an adjusted R² of 0.441, identified several independent contributors. A greater number of comorbidities was associated with higher complexity scores (B = 2.07; p < 0.001), and greater pain intensity was also independently associated with higher complexity (B = 0.54; p = 0.009).
Education emerged as a notable factor. Participants who were illiterate or had only elementary education showed higher complexity scores than those with high school or higher education (B = 3.62; p = 0.011), which the authors interpret as indicating a possible protective role of higher educational attainment in keeping medication regimens manageable.
Treatment strategy itself mattered as well. Although sex was included in the multivariable model, it did not show a statistically significant association with pharmacotherapeutic complexity (B = -2.82; p = 0.19).
The authors conclude that comorbidities, education level, pain intensity, and combination pharmacotherapy were associated with higher pharmacotherapy complexity in individuals with rheumatoid arthritis. They suggest that healthcare services should prioritize identifying patients with these characteristics for multidisciplinary assessment aimed at optimizing and simplifying pharmacotherapy.
As a cross-sectional study of 96 individuals at a single Brazilian teaching hospital, the findings capture associations at one point in time and cannot establish causal relationships. The article was published as open access in Advances in Rheumatology on 1 October 2026 and is being shared early as a citable, peer-reviewed accepted version subject to further edits before the final Version of Record.
Subject of Research: Factors associated with pharmacotherapeutic complexity in rheumatoid arthritis patients in Brazil
Article Title: Comorbidities, education level, and pain as factors associated with pharmacotherapeutic complexity in rheumatoid arthritis
Article References: das Neves Matricardi, J. L., de Queiroz-Cardoso, A. I., Higa, C. M. L., de Arruda, G. O., & Martinez, P. F. (2026). Comorbidities, education level, and pain as factors associated with pharmacotherapeutic complexity in rheumatoid arthritis. Advances in Rheumatology. https://doi.org/10.1186/s42358-026-00561-z
Image Credits: AI Generated
DOI: 10.1186/s42358-026-00561-z
Keywords: rheumatoid arthritis, pharmacotherapy complexity, Medication Regimen Complexity Index, comorbidities, pain intensity, education level, combination therapy, cross-sectional study, Brazil, multivariable regression, education, level
News Source: Courtney Benton. (October 28, 2026). Comorbidities, Pain and Lower Education Linked to Complex Drug Regimens in Rheumatoid Arthritis. Scienmag.
