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Vol. 7. Issue 3.
Pages 172-178 (May - June 2011)
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Vol. 7. Issue 3.
Pages 172-178 (May - June 2011)
Original article
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Differences in the management of early and established rheumatoid arthritis
Diferencias en el manejo de la artritis reumatoide precoz y establecida
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Santos Castañedaa,
Corresponding author
scastas@gmail.com

Corresponding author.
, Federico Navarrob, Cristina Fernández-Carballidoc, Carmelo Tornerod, Elena Marcede, Montserrat Cortegueraf
a Servicio de Reumatología, Hospital Universitario de la Princesa, Madrid, Spain
b Servicio de Reumatología, Hospital Virgen de la Macarena, Sevilla, Spain
c Servicio de Reumatología, Hospital de Elda, Alicante, Spain
d Servicio de Reumatología, Hospital Morales Meseguer, Murcia, Spain
e Departamento Médico, Wyeth Farma, Madrid, Spain
f Servicio de Reumatología, Hospital Nuestra Señora de Sonsoles, Ávila, Spain
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Abstract
Objective

To assess the differences in the clinical and therapeutic management of early and established rheumatoid arthritis (RA) in clinical practice.

Methods

Retrospective and multicentre study including 360 patients diagnosed with RA. During the 12 months prior to the study, onset, sociodemographic, clinical and therapeutic data were collected by clinical chart review.

Results

A total of 152 patients with early RA and 208 with established RA were studied. 97.5% had received disease-modifying anti-rheumatic drugs (DMARDs) and 43.6% a TNFa blocker between the diagnosis and the start of the study. Established RA patients used TNFa blockers more frequently than early RA patients (60.1% vs 21.1%, P<001). Methotrexate was the most commonly used drug (70.6%). A treatment change was seen in 79% of patients with early RA and 60.6% of those with established RA. A dose change was the most frequent modification and an inadequate response the most frequent reason. A 25.8% of treatments were stopped due to adverse events. The mean (SD) decrease on DAS28 score was 0.9 (1.5) on early RA and 0.2 (1.0) on established RA patients. A 35.8% of early RA patients showed a good EULAR response, while only 16.2% among established RA patients (P<.001). Rheumatoid factor and radiological progression assessment were the most requested determinations in early RA (P<.05).

Conclusions

Spanish rheumatologists used biological drugs with a higher frequency in patients with more advanced disease, as recommended in the main clinical practice guidelines.

Keywords:
Rheumatoid arthritis
Early arthritis
Clinical control
TNF-blocking drugs
Disease-modifying anti-rheumatic drugs
Resumen
Objetivo

Evaluar las diferencias en el manejo clínico y terapéutico de la artritis reumatoide (AR) precoz y establecida en la práctica clínica.

Pacientes y método

Estudio retrospectivo y multicéntrico en el que se incluyó a 360 pacientes con diagnóstico de AR. Mediante la revisión de historias clínicas se recogieron variables sociodemográficas, clínicas y terapéuticas en los 12 meses previos al inicio del estudio.

Resultados

Se estudió a 152 pacientes con AR precoz (ARp) y 208 con AR establecida (ARe). El 97,5% había recibido fármacos modificadores de enfermedad (FAME) y el 43,6% tratamiento anti-factor de necrosis tumoral (TNF) entre el diagnóstico y el inicio del estudio. Los anti-TNF fueron utilizados con mayor frecuencia en pacientes con ARe (el 60,1 frente al 21,1%; p < 0,001). El metotrexato fue el fármaco más utilizado (70,6%). Se detectó cambio del tratamiento en un 79% de pacientes con ARp y en el 60,6% con ARe. El cambio de dosis fue la modificación más frecuente y una respuesta inadecuada el motivo más frecuente. El 25,8% de los tratamientos se suspendieron por reacciones adversas. La disminución media ± desviación estándar del DAS28 fue 0,9±1,5 en ARp y 0,2±1,0 en ARe. El 35,8% de las ARp presentó buena respuesta EULAR, mientras sólo el 16,2% de las ARe (p<0,001). La determinación del factor reumatoide y la valoración de la progresión radiológica fueron más solicitadas en la ARp (p<0,05).

Conclusiones

Los reumatólogos españoles utilizaron agentes biológicos con mayor frecuencia en los pacientes con enfermedad más evolucionada, ajustándose a las recomendaciones de las principales guías de práctica clínica.

Palabras clave:
Artritis reumatoide
Artritis precoz
Monitorización clínica
Antagonistas del
TNF Fármacos antirreumáticos
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Copyright © 2011. Sociedad Española de Reumatología and Colegio Mexicano de Reumatología
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