Background Traditionally, only few clinics have participated in reporting results of usual care of patients with Rheumatoid Arthritis (RA). Routine patient monitoring has become more common, which enables collaborative projects to report outcomes of patients with RA. In Finland, a nation-wide review of patients with RA has been missing until to date.
Objectives The objective of the study was to conduct a cross-sectional overview on the demographics, disease activity and medical treatment of patients with RA in outpatient specialized healthcare in Finland.
Methods Consecutive patients from participating centers were enrolled to the study. The data to be collected comprised demographic, disease and treatment-related variables as well as patient reported outcomes. The data were collected using either purpose-made data collection form or alternatively, GoTreatIt- patient monitoring software. The data were analyzed in SPSS 20 statistical software.
Results Between November 2011 and May 2012, 890 patients with RA were enrolled from 14 sites. Percentage of women was 77% while mean age and time from diagnosis were 58.4 (SD 13.8) and 11.6 (SD 11.2) years, respectively. DAS28 values ranged from 0.28 to 6.61 (median 2.55) with 52% and 70% of patients reaching remission and low disease activity, respectively. Meanwhile, according to the ACR/EULAR 2011 remission criteria the proportions of patients in remission were 26% (Boolean) and 28% (SDAI). Rheumatoid factor and CCP-antibodies were evident in 70% and 63% of patients, respectively. Mean HAQ score was 0.87 (SD 0.76)
Conventional disease-modifying anti-rheumatic drugs (DMARD) were used by 91% of patients. A triple therapy of methotrexate (MTX), hydroxychloroquine and sulfasalazine was used by 15%, other MTX-based combination by 30%, MTX alone by 20% and other DMARDs alone or in combination by 26% of patients. In addition, corticosteroids and biologics were taken by 58% and 21% of patients, respectively. Mean weekly dose of methotrexate was 17.7mg (SD 5.4) while mean daily dose of prednisolone was 5.6mg (SD 2.8). Of the 184 biologic drug users 18% were not using DMARDs concomitantly. The most prevalent biologic drugs were etanercept (34%), rituximab (19%), adalimumab (16%) and infliximab (11%). Mean time from diagnosis to initiation of the first biologic treatment was 11.4 years (SD 10.0).
A comparison between hospital districts revealed some differences in disease activity, which may however, have been confounded by heterogeneity in patient demographics and serologic status. There were differences in the proportion of patients on biologic drugs as well as whether intravenously or subcutaneously administered biologics were preferred.
Conclusions Our cross sectional review of patients with RA revealed that >50% of patients were in DAS28-remission and 70% had low disease activity. This observation appeared generalizable among 14 Finnish rheumatology clinics although biologic drugs were only used by 21% of patients. Future prospectives would include similar reviews in other countries to evaluate global generalizability of our results.
Disclosure of Interest None Declared