QUEST-RA: Quantitative clinical assessment of patients with rheumatoid arthritis seen in standard rheumatology care in 15 countries

Tuulikki Sokka ^1*, Hannu Kautiainen ², Sergui Toloza ³, Heidi Mäkinen ¹, Suzanne MM Verstappen ⁴, Merete Lund Hetland ⁵, Antonio Naranjo ⁶, Eva Baecklund ⁷, Gertraud Herborn ⁸, Rolf Rau ⁸, Massimiliano Cazzato ⁹, Laure Gossec ¹⁰, Vlado Skakic ¹¹, Feride Gogus ¹², Stanislaw Sierakowski ¹³, Barry Bresnihan ¹⁴, Peter Taylor ¹⁵, Catherine McClinton ¹⁵ and Theodore Pincus for the QU¹⁶

¹ Jyväskylä Central Hospital, Finland
² Medcare, Finland
³ Hospital San Juan Bautista, Argentina
⁴ University Medical Center Utrecht, Netherlands
⁵ Copenhagen Univ Hospital, Denmark
⁶ Hospital de Gran Canaria Dr. Negrin, Spain
⁷ Uppsala University Hospital, Sweden
⁸ Evangelisches Fachkrankenhaus, Germany
⁹ Santa Chiara Hosp, Italy
¹⁰ Hôpital Cochin, France
¹¹ Rheumatology Institut, Serbia and Montenegro
¹² Gazi Medical School, Turkey
¹³ Medical University in Bialystok, Poland
¹⁴ St. Vincent University Hospital, Eire
¹⁵ Charing Cross Hosp, United Kingdom
¹⁶ Vanderbilt University, United States

^* To whom correspondence should be addressed. E-mail: tuulikki.sokka{at}ksshp.fi.

Accepted 29 March 2007

Abstract

Objective: To conduct a cross sectional review of non-selected consecutive out-patients with rheumatoid arthritis (RA) as part of standard clinical care in 15 countries for an overview of the characteristics of patients with RA.

Methods: The review included current disease activity using data from clinical assessment and a patient self-report questionnaire, which was translated into each language. Data on demographic, disease, and treatment related variables were collected and analyzed using descriptive statistics. Variation in disease activity on DAS28 within and between countries was graphically analyzed. A median regression model was applied to analyze differences in disease activity between countres.

Results: Between January 2005 and October 2006, the QUEST-RA project included 4,363 patients from 48 sites in 15 countries; 78% were female, >90% Caucasian, mean age was 57 years, and mean disease duration was 11.5 years. More than 80% of patients had been treated with methotrexate in all but 3 countries. Overall, patients had an active disease with a median DAS28 of 4.0 with a significant variation between countries (p<0.001). Among 42 sites with >50 patients included, low disease activity of DAS28<3.2 was met by the majority of patients in 7 sites in 5 countries; in 8 sites in 5 other countries >50% of patients had high disease activity of DAS>5.1.

Conclusions: This international multi-center cross sectional database provides an overview of clinical status and treatments of patients with RA in standard clinical care in 2005-06 including countries that are infrequently involved in clinical research projects.

Keywords: DAS28, clinical evaluation, outcomes, rheumatoid arthritis

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