Differences in the management of early and established rheumatoid arthritis

Objective: To assess the differences in the clinical and therapeutic management of early and established rheumatoid arthritis (RA) in clinical practice. Methods: Retrospective and multicentre study including 360 patients diagnosed with RA. During the 12 months prior to the study, onset, sociodemographic, clinical and therapeutic data were collected by clinical chart review. Results: A total of 152 patients with early RA and 208 with established RA were studied. 97.5% had received disease-modifying anti-rheumatic drugs (DMARDs) and 43.6% a TNFa blocker between the diagnosis and the start of the study. Established RA patients used TNFa blockers more frequently than early RA patients (60,1% vs 21,1%, p < 0,001). Methotrexate was the most commonly used drug (70.6%). A treatment change was seen in 79% of patients with early RA and 60.6% of those with established RA. A dose change was the most frequent modification and an inadequate response the most frequent reason. A 25.8% of treatments were stopped due to adverse events. The mean (SD) decrease on DAS28 score was 0.9 (1.5) on early RA and 0.2 (1.0) on established RA patients. A 35.8% of early RA patients showed a good EULAR response, while only 16.2% among established RA patients (p < 0.001). Rheumatoid factor and radiological progression assessment were the most requested determinations in early RA (p < 0.05). Conclusions: Spanish rheumatologists used biological drugs with a higher frequency in patients with more advanced disease, as recommended in the main clinical practice guidelines. (C) 2010 Elsevier Espana, S.L. All rights reserved.