OBJECTIVE: To determine the adequacy of disease modifying antirheumatic drug (DMARD) prescription to disease activity in patients with rheumatoid arthritis (RA) and to assess whether the reasons for DMARD discontinuation agree with published evidence. METHODS: Cross-sectional analysis of the baseline year of a RA cohort (n = 788) randomly selected from the clinical registries of 34 centers. Data about current and previous DMARD use was collected from medical records and confirmed by the patient. Disease activity score (DAS), Health Assessment Questionnaire (HAQ) and Larsen scores, and other clinical data were obtained during the study visit. RESULTS: At baseline visit, 607 patients (77%) were receiving one or more DMARD. Mean DAS, HAQ, and Larsen scores (+/- SD) were: 3.40 +/- 1.22, 1.6 +/- 0.4, and 54.68 +/- 26.37, respectively. Methotrexate (MTX) was the most frequently prescribed DMARD and parenteral gold salts (GS) showed the highest rate of discontinuation. MTX was used as single therapy in a significantly higher proportion (64.3%) than other DMARD (< 50%) and treatment discontinuation due to inefficacy was significantly less frequent (25.5%) than with other DMARD (> 40%). However, the DAS28 was significantly worse in the group treated with MTX in single therapy than in the group treated with GS alone (4.13 vs 3.43; p = 0.032). CONCLUSION: Despite the high use of DMARD among Spanish patients with RA, a significant number of them still have poor control of the disease. In addition, our data show a different perception of ineffectiveness depending on the DMARD used. A non-systematic use of objective quantitative tools for assessment of RA activity and some non-evidence based decisions on the management of DMARD may account for these findings.
OBJECTIVE: To determine the adequacy of disease modifying antirheumatic drug (DMARD) prescription to disease activity in patients with rheumatoid arthritis (RA) and to assess whether the reasons for DMARD discontinuation agree with published evidence. METHODS: Cross-sectional analysis of the baseline year of a RA cohort (n = 788) randomly selected from the clinical registries of 34 centers. Data about current and previous DMARD use was collected from medical records and confirmed by the patient. Disease activity score (DAS), Health Assessment Questionnaire (HAQ) and Larsen scores, and other clinical data were obtained during the study visit. RESULTS: At baseline visit, 607 patients (77%) were receiving one or more DMARD. Mean DAS, HAQ, and Larsen scores (+/- SD) were: 3.40 +/- 1.22, 1.6 +/- 0.4, and 54.68 +/- 26.37, respectively. Methotrexate (MTX) was the most frequently prescribed DMARD and parenteral gold salts (GS) showed the highest rate of discontinuation. MTX was used as single therapy in a significantly higher proportion (64.3%) than other DMARD (< 50%) and treatment discontinuation due to inefficacy was significantly less frequent (25.5%) than with other DMARD (> 40%). However, the DAS28 was significantly worse in the group treated with MTX in single therapy than in the group treated with GS alone (4.13 vs 3.43; p = 0.032). CONCLUSION: Despite the high use of DMARD among Spanish patients with RA, a significant number of them still have poor control of the disease. In addition, our data show a different perception of ineffectiveness depending on the DMARD used. A non-systematic use of objective quantitative tools for assessment of RA activity and some non-evidence based decisions on the management of DMARD may account for these findings.
Authors: Jeffrey R Curtis; Archana Jain; Johan Askling; S Louis Bridges; Loreto Carmona; William Dixon; Axel Finckh; Kimme Hyrich; Jeffrey D Greenberg; Joel Kremer; Joachim Listing; Kaleb Michaud; Ted Mikuls; Nancy Shadick; Daniel H Solomon; Michael E Weinblatt; Fred Wolfe; Angela Zink Journal: Semin Arthritis Rheum Date: 2010-08 Impact factor: 5.532
Authors: Leslie R Harrold; Daniel Peterson; Ashley J Beard; Jerry H Gurwitz; Becky A Briesacher Journal: Am J Med Date: 2012-06-09 Impact factor: 4.965
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Authors: María Galindo-Izquierdo; Esther Rodriguez-Almaraz; José M Pego-Reigosa; Francisco J López-Longo; Jaime Calvo-Alén; Alejandro Olivé; Antonio Fernández-Nebro; Víctor Martinez-Taboada; Paloma Vela-Casasempere; Mercedes Freire; Francisco J Narváez; José Rosas; Mónica Ibáñez-Barceló; Esther Uriarte; Eva Tomero; Antonio Zea; Loreto Horcada; Vicenç Torrente; Iván Castellvi; Joan Calvet; Raúl Menor-Almagro; María A Aguirre Zamorano; Enrique Raya; Elvira Díez-Álvarez; Tomás Vázquez-Rodríguez; Paloma García de la Peña; Atusa Movasat; José L Andreu; Patricia Richi; Carlos Marras; Carlos Montilla-Morales; Blanca Hernández-Cruz; José L Marenco de la Fuente; María Gantes; Eduardo Úcar; Juan J Alegre-Sancho; Javier Manero; Jesús Ibáñez-Ruán; Manuel Rodríguez-Gómez; Víctor Quevedo; José Hernández-Beriaín; Lucía Silva-Fernández; Fernando Alonso; Sabina Pérez; Iñigo Rúa-Figueroa Journal: Medicine (Baltimore) Date: 2016-03 Impact factor: 1.889