Background According to a common consensus, remission/low disease activity is the treatment target in RA. Recommendations to reach the target are surprisingly different: ACR recommendations include a combination of conventional DMARDs for RA but EULAR recommendations strictly suggest a conventional monotherapy and addition of a biologic agent if needed. In many countries, it is not possible to adhere to EULAR recommendations due to high expenses of biologic agents to patients and society.
Objectives To study whether treatment target was reached, which medications were used and how much medications cost, in patients with RA in two Nordic rheumatology clinics in 2010.
Methods Design: Cross sectional observational clinical data of all patients with RA seen in 2010. Setting: Two Nordic county hospital rheumatology units: Kristiansand, Norway (NOR), and Jyväskylä, Finland (FIN), which both serve a population of about 275,000. Treatment philosophy is to reach remission in both clinics. Patients: All consecutive 1140 patients with RA in NOR and 1240 in FIN. Measures: All data were collected as an infrastructure of the clinic using an identical monitoring system to facilitate clinical decision making. Measures included patient demographic measures, clinical characteristics, disease activity, functional status, and treatments. Annual costs of medications to the society were calculated per 100 patients, using an assumption that a patient is taking current medications for one year.
Results Patient populations from NOR and FIN were similar according to age (61 vs. 60), gender (69% vs. 71%F), disease duration (10 vs. 11 years), and prevalence of rheumatoid factor and anti-citrullinated antibodies (Table). Disease activity was low and patients’ functional status well reserved in both clinics. Almost twice as many patients in NOR than in FIN (33% vs 17%) used biologic agents. A combination of conventional anti-rheumatic drugs was currently used by <1% of patients in NOR and by 37% of patients in FIN. Estimated annual costs of medications per 100 patients were 508,000€ in NOR and 280,000€ in FIN.
Conclusions Treatment target of remission/low disease activity and good functional status were seen in patients with RA using expensive and less-expensive anti-rheumatic drugs. This observation may be encouraging to rheumatologists in countries where expensive medications cannot be used.
Disclosure of Interest None Declared
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