Adherence to the prescribed treatment is essential so that children with JIA do not continue to endure joint symptoms, fatigue, reduced physical activity level and lower quality of life [
11] and also to avoid rise of healthcare costs through increased frequency of consultations and diagnostic tests [
1].
Adherence to medications including methotrexate and biological-drugs remains a significant issue in paediatric rheumatology, with alarming reports that as few as 53% of children with rheumatic disease (RD) have good overall drug-adherence [
12]. Bugni et al. (2012) reported that 20 children with RD, equivalent to 20.2% of the participant recruited, had poor medication adherence related to the use of three or more daily medications (
p = 0.047). Specifically to children with JIA, 28(51%) patients were not adherent to the prescribed medication [
12]. Pelajo et al. (2012) investigated 76 outpatients and the overall rate of non-adherence to methotrexate was 18% amongst American and Portuguese children with JIA, between 1 and 17 years old. The rate of reported non-adherence was 8% in Boston and 24% in Rio de Janeiro (
P = 0.012) [
13]. Interestingly, the main reason for non-adherence in Boston was “child refused”, while in Rio de Janeiro non-adherence was mostly related to an inability to acquire the medication [
13]. Multiple reasons should be considered when addressing medication adherence, such as child refusal, adverse effects or lack of medication availability, personal issues, and financial hardship [
12]. Another major reason for adherence failure is forgetfulness [
12]; therefore, in order to encourage children to take their prescribed drugs, parents/carers are often essential to ensuring adherence. It is possible that smart reminders, accessible directly from the patient’s mobile or tablet, may assist medication adherence.
Research in adolescents with asthma has suggested that interactive technologies should be explored as a means of improving medication adherence [
14] including customised reminders accessible through a smartphone app and online information [
15]. A similar approach, to test medication adherence, was successfully introduced by Crosby et al. [
16] in 43 children and adolescents (age range 6–21) with sickle cell disease (SCD) showing 90% satisfaction with patients. This data highlights the potential to integrate smart web-based technology into paediatric clinical care.