Further evaluation of reasons for treatment nonadherence in patients with rheumatologic disease is key in the development of successful interventions. Patient education efforts alone are not sufficient to improve adherence; complex interventions are most effective. Because most rheumatologic diseases require lifetime therapy, the consequences of nonadherence can be deleterious. Several direct and indirect methods have been proposed to measure adherence. Pharmacy claims data have been used frequently in studying rheumatologic disease; electronic monitoring provides an accurate measure. Adherence is mediated through constructs of the patient-physician relationship.