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    First-line DMARD choice in early rheumatoid arthritis – do prognostic factors play a role?

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    Author
    Walsh, David A
    Keyword
    Rheumatoid arthritis
    DMARD choice
    Prognostic factors
    Date
    2010-07
    
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    Publisher's URL
    https://academic.oup.com/rheumatology/article/49/7/1267/1785176
    Abstract
    Objective: To examine if prognostic factors predict the choice of first DMARD for patients with RA. Methods: Details of 616 patients with early RA were collected from 16 centres in the UK Early Rheumatoid Arthritis Network (ERAN). Logistic regression was used to identify whether HAQ score, swollen joint count (SJC), nodules, RF, ESR, CRP and erosions on radiographs were associated with the choice of first DMARD treatment. Results: Of 616 patients, 547 (88%) were started on a DMARD, 253 (46%) on MTX, 230 (42%) on SSZ, 47 (9%) on other DMARD monotherapies and 17 (3%) on combination DMARD therapy (CoT). SSZ was started less frequently in patients with positive RF (P = 0.018; OR 0.59; 95% CI 0.38, 0.91) and high SJC (P = 0.02; OR 0.95; 95% CI 0.91, 0.99). MTX was favoured in patients with high SJC (P = 0.002; OR 1.07; 95% CI 1.02, 1.11). Non-prescription of DMARDs was associated with old age (P = 0.02; OR 0.98; 95% CI 0.96, 0.99) and low HAQ score (P = 0.009; OR 0.80; 95% CI 0.68, 0.95). None of the variables predicted CoT. All other variables and the hospital where the patient was treated were not independently associated with the choice of DMARD. Conclusions: When choosing DMARD monotherapy in early RA, rheumatologists in ERAN seem to preferentially prescribe MTX for patients with a poor prognosis and SSZ for patients with good prognosis. No DMARDs were used in older patients or in those with a low HAQ.
    Citation
    Rachapalli, S. M. et al. (2010) ‘First-line DMARD choice in early rheumatoid arthritis-do prognostic factors play a role?’, RHEUMATOLOGY -LONDON THEN OXFORD- BRITISH SOCIETY FOR RHEUMATOLOGY-, 1 January, pp. 1267–1271
    Publisher
    Rheumatology (Oxford)
    Type
    Article
    URI
    http://hdl.handle.net/20.500.12904/15404
    Collections
    Rheumatology

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