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. 2004 Oct;63(10):1269–1275. doi: 10.1136/ard.2003.015131

Attitudes to early rheumatoid arthritis: changing patterns. Results of a survey

D Aletaha 1, G Eberl 1, V Nell 1, K Machold 1, J Smolen 1
PMCID: PMC1754776  PMID: 15361385

Abstract

Objective: To determine if rheumatologists have changed their views on diagnosis and treatment of early rheumatoid arthritis (RA).

Methods: Three consecutive questionnaires were sent out to international rheumatologists in 1997, 2000, and 2003. The following aspects of early RA were covered: definition; patient referral time; diagnostic means; follow up intervals; and treatment strategies. All initial participants who responded to at least one of the follow up surveys were included in the analysis.

Results: RA is now defined by a smaller number of affected joints (monarthritis: 9.8% respondents in 1997 v 17.4% in 2003), and shorter symptom duration (<3 months: 65.5% in 1997 v 85.8% in 2003). Early referrals (<6 weeks) increased (8.9% in 1997 v 17.4% in 2003). Serological test for diagnosis was mostly rheumatoid factor (100% in 2003), but anti-CCP was already used by 17.4% in 2003. Follow up of patients with early RA intensified (every 2 weeks: 16.1% in 1997 v 30.4% in 2003; every month: 47.8% in 2003 v 64.3% in 1997). Treatment with disease modifying antirheumatic drugs (DMARDs) mainly comprised methotrexate, sulfasalazine, and antimalarial drugs. Leflunomide was among the two favourite DMARDs of 10.9% in 2003, whereas no biological agent was so. In 2003, 46.7% respondents started treatment with DMARDs if RA was suspected (30.9% in 1997); no one waited for erosions to occur (7.3% in 1997).

Conclusion: The data obtained in this study suggest that the concept of diagnosing and treating RA early is accepted by a large proportion of the rheumatological community.

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Figure 1.

Figure 1

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 Cumulative presentation of opinions individually matched for responders to at least one of the follow up questionnaires between 1997 and 2003. The following questions were asked and allowed just one answer (total number of matched responders: n = 56/44/46 for the years 1997/2000/2003): (A) What extent of arthritis do you at least require for a definition of early RA? (valid answers: n = 51/44/46). (B) What maximum duration of symptoms do you still regard as early RA? (valid answers: n = 55/44/46). (C) How long on average from onset of symptoms does it take until patients with arthritis are referred to you? (valid answers: n = 56/44/46).

Figure 2.

Figure 2

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 How often do you see your patients with early arthritis during the first 3 months? Individually matched opinions of responders to at least one of the follow up questionnaires between 1997 and 2003 are presented (total number of matched responders: n = 56/44/46 for the years 1997/2000/2003; there were no missing data). Only the choice of one of the four time intervals was possible for each responder.

Figure 3.

Figure 3

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 When do you start DMARD treatment in patients with newly diagnosed RA? Individually matched opinions of responders to at least one of the follow up questionnaires between 1997 and 2003 are presented (total number of matched responders: n = 56/44/46 for the years 1997/2000/2003; valid answers: n = 55/43/45). Only one choice out of six options (A–E) was possible for each responder. No responder picked the option: NSAID failure >12 months.

Figure 4.

Figure 4

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 DMARD treatment in patients with established RA and early RA. Established RA: Lines present means (SEM) of valid answers on the frequency of DMARD usage in established RA (left score in legends); the rating scale ranged from "1" (not at all) to "5" (very frequently). Valid answers in 1997 (n = 56), 2000 (n = 44), and 2003 (n = 46) for the individual DMARDs given: 50–55/42–44/46. Early RA: Percentages given on right in legends refer to the proportion of responders who stated that they used the respective DMARD in early RA (two choices were allowed; however, percentages may not exactly add up to 200%, because some responders gave only one answer). Valid responders: 55/44/46.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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