[Differences in the management of early and established rheumatoid arthritis]. / Diferencias en el manejo de la artritis reumatoide precoz y establecida.

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.

Diferencias en el manejo de la artritis reumatoide precoz y establecida / Differences in the management of early and established rheumatoid arthritis

Objetivo. Evaluar las diferencias en el manejo clínico y terapéutico de la artritis reumatoide (AR) precoz y establecida en la práctica clínica. Pacientes y método. Estudio retrospectivo y multicéntrico en el que se incluyó a 360 pacientes con diagnóstico de AR. Mediante la revisión de historias clínicas se recogieron variables sociodemográficas, clínicas y terapéuticas en los 12 meses previos al inicio del estudio. Resultados. Se estudió a 152 pacientes con AR precoz (ARp) y 208 con AR establecida (ARe). El 97,5% había recibido fármacos modificadores de enfermedad (FAME) y el 43,6% tratamiento anti-factor de necrosis tumoral (TNF) entre el diagnóstico y el inicio del estudio. Los anti-TNF fueron utilizados con mayor frecuencia en pacientes con ARe (el 60,1 frente al 21,1%; p<0,001). El metotrexato fue el fármaco más utilizado (70,6%). Se detectó cambio del tratamiento en un 79% de pacientes con ARp y en el 60,6% con ARe. El cambio de dosis fue la modificación más frecuente y una respuesta inadecuada el motivo más frecuente. El 25,8% de los tratamientos se suspendieron por reacciones adversas. La disminución media±desviación estándar del DAS28 fue 0,9±1,5 en ARp y 0,2±1,0 en ARe. El 35,8% de las ARp presentó buena respuesta EULAR, mientras sólo el 16,2% de las ARe (p<0,001). La determinación del factor reumatoide y la valoración de la progresión radiológica fueron más solicitadas en la ARp (p<0,05). Conclusiones. Los reumatólogos españoles utilizaron agentes biológicos con mayor frecuencia en los pacientes con enfermedad más evolucionada, ajustándose a las recomendaciones de las principales guías de práctica clínica (AU)

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 (AU)