Original article
Descriptive study of the use of DMARD in patients with Rheumatoid arthritis or persistent arthritis who start drug treatment in Spain (FIRST)
Estudio descriptivo de la utilización de los FAMES en los pacientes con artritis reumatoide o artritis persistente que inician tratamiento farmacológico en España. (ESTUDIO FIRST)
Francisco Javier Blancoa,
, Javier Ballinab, Jordi Carbonellc, Emilio Martín-Molad, Jesús Torneroe, Esteban Ramírezf, Jordi Galváng
Corresponding author
a Servicio de Reumatología, Hospital Universitario A Coruña, A Coruña, Galicia, Spain
b Servicio de Reumatología, Hospital Central de Asturias, Oviedo, Asturias, Spain
c Servicio de Reumatología, Hospital del Mar, Barcelona, Catalonia, Spain
d Servicio de Reumatología, Hospital de la Paz, Madrid, Spain
e Servicio de Reumatología, Hospital Universitario de Guadalajara, Guadalajara, Castilla-La Mancha, Spain
f Infociencia S.L., Barcelona, Catalonia, Spain
g Departamento Médico, Laboratorios Gebro Pharma S.A., Barcelona, Catalonia, Spain
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(ESTUDIO FIRST)" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec112656" "palabras" => array:4 [ 0 => "DMARD" 1 => "Rheumatoid arthritis" 2 => "Persistent arthritis" 3 => "Methotrexate" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec112657" "palabras" => array:4 [ 0 => "FAME" 1 => "Artritis reumatoide" 2 => "Artritis persistente" 3 => "Metotrexato" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Rheumatoid arthritis is clinically very heterogeneous and variable in its progression, and no one treatment works the same for all patients, as this will depend on the clinical course and specific situations.</p> <span class="elsevierStyleSectionTitle">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To describe the treatment with DMARDs established for the first time in patients with rheumatoid arthritis (RA) or persistent arthritis (PA) in routine clinical practice in Spain.</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Epidemiological, cross-sectional, uncontrolled, multicenter study in 15 regions of Spain during a period of five months (July to November 2006). We included patients of both genders, aged 18 years and diagnosed with RA according to ACR criteria or PA defined as any arthritis (oligoarthritis or polyarthritis) lasting ≥12 weeks, which would be given DMARD to treat their disease.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">1079 patients were recruited, 915 analyzed (33% ♂/♀ 67%) meeting all the criteria required to be evaluated in the study. Mean age of patients was 54.6 (SD=15.4) years. The mean time from onset of symptoms until the 1st visit with the rheumatologist was 6.3 (11.3) months and the time from the 1st visit with the rheumatologist and the start of treatment was 4 (13.5) months. Of the patients tested, 96.7% was treated with at least one DMARD, 62.1% were given NSAIDs, corticosteroids to 59.2% and 3.8% biological therapy. In patients who received DMARDs, 90.3% received treatment with a single DMARD, 9.5% with 2 DMARDs and 0.2% with three DMARDs. In polytherapy, the DMARDs that are most often administered together were MTX + hydroxychloroquine (4.8%), MTX+leflunomide (2.0%) and MTX + sulfasalazine (1.5%). The most frequently used DMARD in monotherapy was MTX (81.3%), followed by leflunomide (4.1%) and hydroxychloroquine (3.2%). In 89.6%, the treatment of first choice was adequate according to the SER.</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The most common pattern of initial treatment of RA is MTX monotherapy. Treatment of RA by rheumatologists has been homogenized in recent years.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Introducción</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La artritis reumatoide es clínicamente muy heterogénea y variable en su evolución, lo que ocasiona que no se pueda detallar un mismo tratamiento para todos los pacientes, ya que éste va a depender del curso clínico y de situaciones concretas que se van a presentar a lo largo del mismo.</p> <span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Realizar una descripción del tratamiento con fármacos modificadores de la enfermedad (FAME) que se instauran por primera vez en pacientes con artritis reumatoide (AR) o artritis persistente (AP) en la práctica clínica habitual en España.</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Estudio epidemiológico, transversal, no controlado, multicéntrico realizado en 15 comunidades autónomas de España durante un período de 5 meses (julio a noviembre del 2006). Se incluyeron pacientes de ambos sexos, mayores de 18 años y diagnosticados de AR según los criterios de la ACR o bien de AP definida como toda artritis (oligoartritis o poliartritis) ≥ 12 semanas de duración, a los que se les iba a administrar el primer FAME para tratar su enfermedad.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se reclutaron 1.079 pacientes, pero finalmente, 915 (33% ♂/67% ♀) cumplieron todos los criterios exigidos para ser evaluados en el estudio. La edad media de los pacientes fue de 54,6 (DE<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>15,4) años. El tiempo medio desde la aparición de los síntomas hasta la 1.a visita con el reumatólogo fue de 6,3 (11,3) meses y el tiempo desde la 1.a visita con el reumatólogo y el inicio del tratamiento fue de 4 (13,5) meses. Del total de pacientes evaluados, al 96,7% se les instauró tratamiento con al menos un FAME, al 62,1% se les administraron AINE, al 59,2% corticoesteroides y al 3,8% una terapia biológica. En los pacientes que recibieron FAME, el 90,3% recibió tratamiento con un solo FAME, el 9,5% con 2 FAME y el 0,2% con 3 FAME. En politerapia, los FAME que más a menudo se administraron conjuntamente fueron MTX + hidroxicloroquina (4,8%), MTX + leflunomida (2,0%) y MTX + sulfasalazina (1,5%). El FAME más frecuentemente utilizado en monoterapia fue el MTX (81,3%), seguido de la leflunomida (4,1%) y la hidroxicloroquina (3,2%). En el 89,6%, el tratamiento de primera elección fue el adecuado según las recomendaciones de la SER.</p> <span class="elsevierStyleSectionTitle">Conclusión</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">La pauta de tratamiento de inicio de la AR más frecuente es el MTX en monoterapia. 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"referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Early referral and outcome in rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D.A. Houssien" 1 => "D.L. Scott" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Scand J Rheumatol" "fecha" => "1998" "volumen" => "27" "paginaInicial" => "300" "paginaFinal" => "302" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9751472" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib13" "etiqueta" => "13." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multinational evidence-based recommendations for the use of methotrexate in rheumatic disorders with a focus on rheumatoid arthritis: integrating systematic literature research and expert opinion of a broad international panel of rheumatologists in the 3E Initiative" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K. Visser" 1 => "W. Katchamart" 2 => "E. Loza" 3 => "J.A. Martinez-Lopez" 4 => "C. Salliot" 5 => "J. Trudeau" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/ard.2008.094474" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2009" "volumen" => "68" "paginaInicial" => "1086" "paginaFinal" => "1093" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19033291" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000000700000002/v1_201305061619/S2173574311700181/v1_201305061619/en/main.assets" "Apartado" => array:4 [ "identificador" => "17338" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Original Article" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000000700000002/v1_201305061619/S2173574311700181/v1_201305061619/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574311700181?idApp=UINPBA00004M" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 10 | 15 | 25 |
| 2024 October | 35 | 41 | 76 |
| 2024 September | 43 | 20 | 63 |
| 2024 August | 51 | 36 | 87 |
| 2024 July | 43 | 30 | 73 |
| 2024 June | 49 | 28 | 77 |
| 2024 May | 42 | 25 | 67 |
| 2024 April | 39 | 26 | 65 |
| 2024 March | 52 | 31 | 83 |
| 2024 February | 43 | 21 | 64 |
| 2024 January | 39 | 20 | 59 |
| 2023 December | 37 | 42 | 79 |
| 2023 November | 27 | 28 | 55 |
| 2023 October | 33 | 35 | 68 |
| 2023 September | 55 | 39 | 94 |
| 2023 August | 34 | 13 | 47 |
| 2023 July | 44 | 18 | 62 |
| 2023 June | 39 | 18 | 57 |
| 2023 May | 46 | 14 | 60 |
| 2023 April | 43 | 12 | 55 |
| 2023 March | 39 | 23 | 62 |
| 2023 February | 30 | 29 | 59 |
| 2023 January | 34 | 20 | 54 |
| 2022 December | 34 | 35 | 69 |
| 2022 November | 58 | 20 | 78 |
| 2022 October | 39 | 28 | 67 |
| 2022 September | 29 | 34 | 63 |
| 2022 August | 50 | 45 | 95 |
| 2022 July | 26 | 39 | 65 |
| 2022 June | 36 | 40 | 76 |
| 2022 May | 42 | 55 | 97 |
| 2022 April | 41 | 73 | 114 |
| 2022 March | 43 | 60 | 103 |
| 2022 February | 25 | 36 | 61 |
| 2022 January | 28 | 43 | 71 |
| 2021 December | 34 | 48 | 82 |
| 2021 November | 31 | 59 | 90 |
| 2021 October | 48 | 54 | 102 |
| 2021 September | 41 | 41 | 82 |
| 2021 August | 32 | 52 | 84 |
| 2021 July | 36 | 34 | 70 |
| 2021 June | 34 | 55 | 89 |
| 2021 May | 25 | 31 | 56 |
| 2021 April | 82 | 83 | 165 |
| 2021 March | 74 | 31 | 105 |
| 2021 February | 32 | 26 | 58 |
| 2021 January | 42 | 17 | 59 |
| 2020 December | 28 | 13 | 41 |
| 2020 November | 29 | 39 | 68 |
| 2020 October | 19 | 20 | 39 |
| 2020 September | 30 | 20 | 50 |
| 2020 August | 33 | 22 | 55 |
| 2020 July | 23 | 13 | 36 |
| 2020 June | 53 | 25 | 78 |
| 2020 May | 71 | 17 | 88 |
| 2020 April | 74 | 20 | 94 |
| 2020 March | 31 | 10 | 41 |
| 2020 February | 1 | 0 | 1 |
| 2020 January | 5 | 0 | 5 |
| 2019 December | 2 | 0 | 2 |
| 2019 November | 1 | 0 | 1 |
| 2019 October | 1 | 0 | 1 |
| 2019 September | 13 | 0 | 13 |
| 2019 June | 2 | 0 | 2 |
| 2019 March | 2 | 0 | 2 |
| 2019 January | 2 | 0 | 2 |
| 2018 May | 3 | 2 | 5 |
| 2018 April | 21 | 8 | 29 |
| 2018 March | 17 | 15 | 32 |
| 2018 February | 12 | 6 | 18 |
| 2018 January | 12 | 6 | 18 |
| 2017 December | 19 | 6 | 25 |
| 2017 November | 14 | 9 | 23 |
| 2017 October | 15 | 6 | 21 |
| 2017 September | 14 | 4 | 18 |
| 2017 August | 13 | 9 | 22 |
| 2017 July | 16 | 7 | 23 |
| 2017 June | 22 | 12 | 34 |
| 2017 May | 25 | 18 | 43 |
| 2017 April | 15 | 7 | 22 |
| 2017 March | 10 | 4 | 14 |
| 2017 February | 9 | 4 | 13 |
| 2017 January | 22 | 2 | 24 |
| 2016 December | 59 | 12 | 71 |
| 2016 November | 28 | 2 | 30 |
| 2016 October | 55 | 14 | 69 |
| 2016 September | 39 | 3 | 42 |
| 2016 August | 24 | 4 | 28 |
| 2016 July | 18 | 13 | 31 |
| 2016 June | 2 | 0 | 2 |
| 2016 May | 1 | 6 | 7 |
| 2016 March | 1 | 0 | 1 |
| 2016 February | 1 | 8 | 9 |
| 2015 December | 3 | 0 | 3 |
| 2015 October | 1 | 0 | 1 |
| 2015 September | 4 | 14 | 18 |
| 2015 August | 3 | 0 | 3 |
| 2015 July | 27 | 5 | 32 |
| 2015 June | 32 | 10 | 42 |
| 2015 May | 29 | 19 | 48 |
| 2015 April | 19 | 16 | 35 |
| 2015 March | 26 | 12 | 38 |
| 2015 February | 30 | 14 | 44 |
| 2015 January | 14 | 13 | 27 |
| 2014 December | 25 | 16 | 41 |
| 2014 November | 27 | 13 | 40 |
| 2014 October | 21 | 9 | 30 |
| 2014 September | 21 | 11 | 32 |
| 2014 August | 23 | 16 | 39 |
| 2014 July | 28 | 22 | 50 |
| 2014 June | 43 | 10 | 53 |
| 2014 May | 43 | 11 | 54 |
| 2014 April | 28 | 14 | 42 |
| 2014 March | 47 | 18 | 65 |
| 2014 February | 34 | 10 | 44 |
| 2014 January | 27 | 24 | 51 |
| 2013 December | 23 | 10 | 33 |
| 2013 November | 25 | 12 | 37 |
| 2013 October | 34 | 16 | 50 |
| 2013 September | 32 | 8 | 40 |
| 2013 August | 25 | 9 | 34 |
| 2013 July | 23 | 12 | 35 |
| 2013 June | 20 | 12 | 32 |
| 2013 May | 24 | 16 | 40 |
| 2013 April | 23 | 12 | 35 |
| 2013 March | 16 | 10 | 26 |
| 2013 February | 24 | 10 | 34 |
| 2013 January | 17 | 8 | 25 |
| 2012 December | 12 | 11 | 23 |
| 2012 November | 9 | 13 | 22 |
| 2012 October | 4 | 12 | 16 |
| 2012 September | 7 | 6 | 13 |
| 2012 June | 2 | 0 | 2 |
| 2012 May | 1 | 0 | 1 |
| 2012 April | 4 | 0 | 4 |
| 2012 March | 4 | 0 | 4 |
| 2012 February | 4 | 0 | 4 |
| 2012 January | 4 | 0 | 4 |
| 2011 December | 6 | 0 | 6 |
| 2011 November | 4 | 0 | 4 |
| 2011 October | 2 | 0 | 2 |
| 2011 September | 1 | 0 | 1 |
| 2011 August | 2 | 0 | 2 |
| 2011 July | 7 | 0 | 7 |
| 2011 June | 6 | 0 | 6 |
| 2011 May | 5 | 0 | 5 |
| 2011 April | 15 | 0 | 15 |
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