Determining best practices in early rheumatoid arthritis by comparing differences in treatment at sites in the Canadian Early Arthritis Cohort. Academic Article Article uri icon

Overview

MeSH

  • Adult
  • Canada
  • Disease Progression
  • Drug Therapy, Combination
  • Female
  • Humans
  • Male
  • Methotrexate
  • Middle Aged
  • Remission Induction
  • Severity of Illness Index
  • Treatment Outcome

MeSH Major

  • Antirheumatic Agents
  • Arthritis, Rheumatoid
  • Practice Guidelines as Topic
  • Standard of Care

abstract

  • To determine site variation by comparing outcomes across sites in an early rheumatoid arthritis cohort. Sites from the Canadian Early Arthritis Cohort database with at least 40 patients were studied. Comparisons were made among sites in change in 28-joint Disease Activity Score (DAS28), proportion of patients in DAS28 remission, and treatment strategies. The study included 1138 baseline patients at 8 sites, with baseline (SD) age 52 years (16.9); 72% women; 23% erosions; 54% ever smokers; 51% rheumatoid factor-positive; 37% anticitrullinated protein antibody-positive; disease duration 187 (203) days; DAS28 4.5 (1.4). Site had an effect on outcomes when adjusting for confounders. At 6 and 12 months, sites B and H, the 2 largest sites, had the best changes in DAS28 (-1.82 and -2.09, respectively, at 6 mos, and -2.27 for both at 12 mos; p < 0.001). Site H had the most patients in DAS28 remission at 6 months [64.5% compared to other sites that had from 34.1% to 51.7% (p < 0.001)], and at the last followup, sites B and H had the most in remission. Subcutaneous methotrexate was used more overall and earlier at sites B and H. Those sites used less steroid therapy, and site B had the second-highest use of triple disease-modifying antirheumatic drugs at any visit. Medications were increased more in 2 of the 3 smallest sites. Biologics were used by 9 months most in the smallest (50.0%) and then largest (19.6%) sites. Sites in an early inflammatory arthritis cohort yielded different outcomes. Better outcomes up to 12 months may result from initial treatment with early combination therapy and/or subcutaneous methotrexate.

publication date

  • November 2013

has subject area

  • Adult
  • Antirheumatic Agents
  • Arthritis, Rheumatoid
  • Canada
  • Disease Progression
  • Drug Therapy, Combination
  • Female
  • Humans
  • Male
  • Methotrexate
  • Middle Aged
  • Practice Guidelines as Topic
  • Remission Induction
  • Severity of Illness Index
  • Standard of Care
  • Treatment Outcome

Research

keywords

  • Comparative Study
  • Journal Article

Identity

Language

  • eng

Digital Object Identifier (DOI)

  • 10.3899/jrheum.121316

PubMed ID

  • 24037554

Additional Document Info

start page

  • 1823

end page

  • 1830

volume

  • 40

number

  • 11