Treatment Perspectives in Rheumatoid Arthritis

Summary

This study analyses patterns of treatment offered to individuals with a clinical diagnosis of rheumatoid arthritis (RA).

A cross-sectional investigation was carried out in 321 patienls (aged > 16 years) fulfilling the 1958 American Rheumatism Association (ARA) criteria for RA. Medical records were scrutinised retrospectively for information about medical, surgical and other treatments during a 5-year period (1982 to 1986).

All patients had received medical treatment, but a large number had discontinued drug therapy because of adverse effects or lack of efficacy, 45.9% of the individuals were receiving 1 drug at the time of the survey, 33.8% were on 2 drugs, 11.7% were on 3 or 4 drugs, and 8.6% were not receiving any medication. Nearly 50% of the patients had had various kinds of surgical procedures performed. The clinical manifestation of the disease, as measured by the number of ARA criteria fulfilled, showed a linear correlation to nearly all medical and surgical treatments. A primary healthcare physician was the basic contact person for 90% of the patients, but in addition 70% of the participants had been examined at sometime by a rheumatological specialist.

The study confirms our expectations that patients with RA receive numerous pharmaceutical and other treatments. Even patients with mild and/or early disease (probable RA) had received a considerable amount of treatment. Qualified specialised care was also provided despite the distance to a university referral centre.

Increased compliance by patients receiving drug therapy for RA might have pharmacoeconomic benefits through a lower incidence of discontinuation of treatment due to lack of effect.