Background The emAR study was developed to determine variations in the management of socio-sanitary resources, including drugs use, in patients with rheumatoid arthritis (RA) and Spondyloarthritis (Spa).
Objectives To evaluate the fulfillment degree of some GUIPCAR-2007 recommendations in EMAR-II participating centers managing patients with recent-onset rheumatoid arthritis.
Methods The clinical records of 1,272 patients, randomly selected among all RA patients attended in Spanish hospitals, were reviewed.Only patients with RA diagnosed within the period of 2 years before September 1st 2009 were selected for the present analysis. GUIPCAR-2007 (Clinical Practice Guideline for the Management of Rheumatoid Arthritis) is available at www.ser.es. Information about of waiting time from the suspicion of arthritis until is treated by a rheumatologist, clinical-analytic assessment (ESR, CRP, anti-PCC, biochemistry, serology, SJC, TJC, VAS for pain, VAS forpatient global and physician), physic function (HAQ) and radiological assessment were collected. In addition, information about prescription of disease modifying anti-rheumatic drugs (DMARD), non-steroidal anti-inflammatory drugs (NSAID), corticosteroids, analgesics, gastric protectors and drugs for osteoporosis was also collected in each patient. Sensitivity analysis according missing data was performed to assess the validity of study results.
Results 113 recent-onset RA patients among 1,272 included in emAR-II were studied. A waiting-time for assessment in rheumatology department less 2 weeks was fulfilled in only 7.4% of cases. The fulfillment and adherence to the GUIPCAR-2007 recommendationswas quite high (>80%) except for the realization of serology (59%), all data to calculate DAS28 (Disease Activity Score using 28 joint count) (41.6%), HAQ (Health Assessment Questionnaire) (20.3%), imaging test (X-Rays, ultrasonnography, and NMR included) was performed in ≤20%. Both the early use of DMARDs (including methotrexate as first option) as properly use of NSAIDs, were fulfilled in most of centres. The validity of data was greater than 70% in the present analysis. The best data were collected on the clinical assessment,inflammatory activity, physic function, NSAIDs use, and local infiltrations, while the worst data were collected on time until the first DMARD and imaging assessment.
Conclusions The quality of the data according to the number of missing values in the emAR-II study following some important GUIPCAR-2007 recommendations was good. Based on these data, most centers perform a clinical and laboratory assessment rather complete. However, the waiting-time to access to a rheumatologist should be shorter in patients with suspected RA, and the use of ultrasound should be incorporated as a routine in the clinical practice.
Disclosure of Interest None Declared
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