Smoldering rheumatoid arthritis: is the Canadian healthcare system neglecting a significant disease population? Academic Article uri icon

Overview

MeSH

  • Adult
  • Aged
  • Canada
  • Female
  • Humans
  • Male
  • Middle Aged
  • National Health Programs
  • Remission Induction

MeSH Major

  • Antirheumatic Agents
  • Arthritis, Rheumatoid
  • Medical Audit
  • Practice Patterns, Physicians'

abstract

  • To investigate rheumatology practice in Canada with regard to evaluating disease activity status and treatment regimens in patients with rheumatoid arthritis (RA). It was hypothesized that patients with "smoldering" disease activity were not being adequately treated. Rheumatologists were invited to participate by the Canadian Rheumatology Association in an audit entitled the Assessment in Rheumatology (AIR) program. From across Canada, 65 rheumatologists participated. One thousand five hundred ninety-six consecutive patients with RA seen in regular clinics were classified according to 4 states of disease activity: remission, controlled adequately, smoldering, and uncontrolled. Demographics (age, sex, geographic region), therapy (nonsteroidal antiinflammatory drugs, disease modifying antirheumatic drugs, biologicals, steroids), joint counts (tender/swollen), comorbidity, and treatment decisions at the time of the visit were recorded. Data were collected at the time of the visit with personal digital assistants (PDA) and aggregated, without personal identifiers, for analysis in SPSS. The majority of patients had "smoldering" (29%) or "uncontrolled" disease (23%), with the remainder in "remission" (15%) or "controlled adequately" (33%) at the time of their visit. Following the appointment, the uncontrolled group had a 100% increase (from 10.4% to 23.4%) in the addition of biological agents; however, there was no significant increase in the rates for those with smoldering disease (19.4% to 20.5%). Despite Canada's universal healthcare system, current treatment regimens may not be optimized on the basis of disease activity. A large proportion of patients with RA (29%) seen in Canadian rheumatology practices may be experiencing unnecessary disease for a variety of reasons.

publication date

  • August 2008

has subject area

  • Adult
  • Aged
  • Antirheumatic Agents
  • Arthritis, Rheumatoid
  • Canada
  • Female
  • Humans
  • Male
  • Medical Audit
  • Middle Aged
  • National Health Programs
  • Practice Patterns, Physicians'
  • Remission Induction

Research

keywords

  • Journal Article

Identity

Language

  • eng

PubMed ID

  • 18597407

Additional Document Info

start page

  • 1506

end page

  • 1512

volume

  • 35

number

  • 8