Article Text

Trends in disease modifying antirheumatic drug prescription in early rheumatoid arthritis are influenced more by hospital setting than patient or disease characteristics
  1. C Carli1,2,
  2. A G C Ehlin3,
  3. L Klareskog2,
  4. S Lindblad1,2,
  5. S M Montgomery3,4,
  6. for the Swedish Rheumatoid Arthritis Register*
  1. 1Medical Management Centre (MMC), Department of Learning, Informatics, Management & Ethics, Karolinska Institutet, Stockholm, Sweden
  2. 2Rheumatology Unit, Department of Medicine, Karolinska Hospital, Karolinska Institutet Stockholm, Sweden
  3. 3Clinical Epidemiology Unit, Department of Medicine, Karolinska Hospital, Karolinska Institutet, Stockholm, Sweden
  4. 4Clinical Research Centre, Örebro University Hospital, Örebro, Sweden
  1. Correspondence to:
    MsC Carli
    Karolinska University Hospital D2:01, 171 76 Stockholm, Sweden; Cheryl.Cullinane-Carli{at}


Objective: To characterise temporal trends and factors associated with the prescription of disease modifying antirheumatic drugs (DMARDs) at the initial consultation in early rheumatoid arthritis (RA).

Methods: Data from 2584 patients with early RA at 19 hospitals were extracted from the Swedish Rheumatoid Arthritis Register for the period 1997–2001. Disease characteristics and DMARD prescription at first consultation with the rheumatologist were investigated using cross tabulation and logistic regression.

Results: DMARD prescriptions, particularly for methotrexate, increased from 1997 to 2001 independently of patient characteristics. Stratification by hospital type showed that patients in district hospitals were less likely to be prescribed DMARDs than those in university hospitals (adjusted odds ratio (OR) = 0.53 (95% confidence interval (CI) 0.40 to 0.69), p<0.001), independently of confounding factors. Association of the DAS28 with the likelihood of DMARD prescription was greater among patients attending district hospitals (OR = 1.65 (1.34 to 2.02), p<0.001) than those at university hospitals (OR = 1.23 (1.07 to 1.41), p = 0.003) and county hospitals (OR = 1.34 (1.01 to 1.63), p = 0.003). Interaction testing indicated that the difference was significant (p = 0.007).

Conclusions: Temporal trends in DMARD prescription indicate an increasingly aggressive approach to disease management among Swedish rheumatologists. However, the association of hospital type with DMARD prescription suggests that the adoption of research findings in clinical care varies considerably.

  • CI, confidence interval
  • DAS28, 28 joint count Disease Activity Score
  • DMARD, disease modifying antirheumatic drug
  • GCs, glucocorticosteroids
  • HAQ, Health Assessment Questionnaire
  • OR, odds ratio
  • RA, rheumatoid arthritis
  • RF, rheumatoid factor
  • early rheumatoid arthritis
  • disease modifying antirheumatic drug
  • temporal trends
  • register

Statistics from


  • * A full list of the contributing centres is given in the Acknowledgements.

  • Financial support was provided by the Swedish National Board of Health and Welfare, and The Swedish Medical Research Council.

  • Competing interests: None.

  • Published Online First 1 December 2006

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