Background Current recommendations advocate treatment with disease-modifying anti-rheumatic drugs (DMARDs) in all patients with active rheumatoid arthritis (RA). However, results from contemporary RA cohorts show that even in specialized rheumatology clinics, a proportion of patients are not treated with DMARDs.
Objectives We investigated the frequency of and reasons for inconsistent DMARD use among patients in a clinical rheumatology cohort.
Methods Patients in the Brigham Rheumatoid Arthritis Sequential Study were studied for DMARD use (any or none) at each semi-annual study time point during the first two study years. Inconsistent use was defined as DMARD use at ≤40% of study time points. Characteristics were compared between inconsistent and consistent users (>40%), and factors associated with inconsistent DMARD use were determined through multivariate logistic regression. A medical record review was performed to determine the reasons for inconsistent use.
Results Of 848 patients with sufficient follow-up data, 55 (6.5%) were inconsistent DMARD users. Higher age, longer disease duration and rheumatoid factor negativity were statistically significant correlates of inconsistent use in the multivariate analyses (table). The primary reasons for inconsistent use identified through chart review, allowing for up to 2 co-primary reasons, were inactive disease (n=28, 50.9%), intolerance to DMARDs (n=18, 32.7%), patient preference (n=7, 12.7%), comorbidity (n=6, 10.9%), DMARDs not being effective (n=3, 5.5%), and pregnancy (n=3, 5.5%). During subsequent follow-up, 14/45 (31.1%) of inconsistent users with sufficient data became consistent users of DMARDs.
Conclusions A small proportion of RA patients in a clinical rheumatology cohort were inconsistent DMARD users during the first two years of follow up. Several patient factors correlate with inconsistent use, and many patients re-start DMARDs and become consistent users over time.
Disclosure of Interest None declared