Original article
Differences in the management of early and established rheumatoid arthritis
Diferencias en el manejo de la artritis reumatoide precoz y establecida
Santos Castañedaa,
, Federico Navarrob, Cristina Fernández-Carballidoc, Carmelo Tornerod, Elena Marcede, Montserrat Cortegueraf
Corresponding author
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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"aff0025" ] 5 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Nuestra Señora de Sonsoles, Ávila, Spain" "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff0030" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "*" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Diferencias en el manejo de la artritis reumatoide precoz y establecida" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2010-03-02" "fechaAceptado" => "2010-08-18" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec112732" "palabras" => array:5 [ 0 => "Rheumatoid arthritis" 1 => "Early arthritis" 2 => "Clinical control" 3 => "TNF-blocking drugs" 4 => "Disease-modifying anti-rheumatic drugs" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec112733" "palabras" => array:5 [ 0 => "Artritis reumatoide" 1 => "Artritis precoz" 2 => "Monitorización clínica" 3 => "Antagonistas del" 4 => "TNF Fármacos antirreumáticos" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To assess the differences in the clinical and therapeutic management of early and established rheumatoid arthritis (RA) in clinical practice.</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">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<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>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<span class="elsevierStyleHsp" style=""></span><.001). Rheumatoid factor and radiological progression assessment were the most requested determinations in early RA (P<span class="elsevierStyleHsp" style=""></span><.05).</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Spanish rheumatologists used biological drugs with a higher frequency in patients with more advanced disease, as recommended in the main clinical practice guidelines.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Evaluar las diferencias en el manejo clínico y terapéutico de la artritis reumatoide (AR) precoz y establecida en la práctica clínica.</p> <span class="elsevierStyleSectionTitle">Pacientes y método</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">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<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1,5 en ARp y 0,2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1,0 en ARe. El 35,8% de las ARp presentó buena respuesta EULAR, mientras sólo el 16,2% de las ARe (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001). La determinación del factor reumatoide y la valoración de la progresión radiológica fueron más solicitadas en la ARp (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,05).</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">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.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:29 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Lozano JA. Artritis reumatoide (I). Etiopatogenia, sintomatología, diagnóstico y pronóstico accessed 2010 Jun 8]. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 23 | 31 |
| 2024 October | 22 | 26 | 48 |
| 2024 September | 32 | 17 | 49 |
| 2024 August | 38 | 39 | 77 |
| 2024 July | 31 | 39 | 70 |
| 2024 June | 40 | 26 | 66 |
| 2024 May | 36 | 33 | 69 |
| 2024 April | 37 | 23 | 60 |
| 2024 March | 52 | 25 | 77 |
| 2024 February | 25 | 25 | 50 |
| 2024 January | 20 | 23 | 43 |
| 2023 December | 17 | 29 | 46 |
| 2023 November | 23 | 21 | 44 |
| 2023 October | 32 | 34 | 66 |
| 2023 September | 26 | 42 | 68 |
| 2023 August | 16 | 14 | 30 |
| 2023 July | 31 | 24 | 55 |
| 2023 June | 19 | 23 | 42 |
| 2023 May | 26 | 27 | 53 |
| 2023 April | 30 | 31 | 61 |
| 2023 March | 27 | 33 | 60 |
| 2023 February | 26 | 28 | 54 |
| 2023 January | 23 | 23 | 46 |
| 2022 December | 34 | 39 | 73 |
| 2022 November | 46 | 26 | 72 |
| 2022 October | 32 | 26 | 58 |
| 2022 September | 38 | 36 | 74 |
| 2022 August | 50 | 52 | 102 |
| 2022 July | 57 | 43 | 100 |
| 2022 June | 30 | 43 | 73 |
| 2022 May | 42 | 63 | 105 |
| 2022 April | 31 | 47 | 78 |
| 2022 March | 28 | 42 | 70 |
| 2022 February | 40 | 39 | 79 |
| 2022 January | 39 | 45 | 84 |
| 2021 December | 23 | 45 | 68 |
| 2021 November | 29 | 63 | 92 |
| 2021 October | 33 | 60 | 93 |
| 2021 September | 29 | 50 | 79 |
| 2021 August | 20 | 54 | 74 |
| 2021 July | 16 | 35 | 51 |
| 2021 June | 23 | 40 | 63 |
| 2021 May | 44 | 46 | 90 |
| 2021 April | 67 | 111 | 178 |
| 2021 March | 58 | 29 | 87 |
| 2021 February | 33 | 28 | 61 |
| 2021 January | 26 | 16 | 42 |
| 2020 December | 36 | 17 | 53 |
| 2020 November | 28 | 22 | 50 |
| 2020 October | 23 | 14 | 37 |
| 2020 September | 23 | 23 | 46 |
| 2020 August | 20 | 19 | 39 |
| 2020 July | 23 | 9 | 32 |
| 2020 June | 28 | 19 | 47 |
| 2020 May | 28 | 14 | 42 |
| 2020 April | 28 | 20 | 48 |
| 2020 March | 19 | 10 | 29 |
| 2020 February | 2 | 0 | 2 |
| 2020 January | 4 | 0 | 4 |
| 2019 September | 6 | 0 | 6 |
| 2019 June | 2 | 0 | 2 |
| 2019 March | 2 | 0 | 2 |
| 2019 January | 1 | 0 | 1 |
| 2018 May | 3 | 1 | 4 |
| 2018 April | 16 | 8 | 24 |
| 2018 March | 19 | 13 | 32 |
| 2018 February | 11 | 3 | 14 |
| 2018 January | 17 | 8 | 25 |
| 2017 December | 13 | 5 | 18 |
| 2017 November | 16 | 5 | 21 |
| 2017 October | 18 | 9 | 27 |
| 2017 September | 11 | 7 | 18 |
| 2017 August | 8 | 10 | 18 |
| 2017 July | 14 | 5 | 19 |
| 2017 June | 27 | 18 | 45 |
| 2017 May | 27 | 13 | 40 |
| 2017 April | 18 | 7 | 25 |
| 2017 March | 11 | 42 | 53 |
| 2017 February | 6 | 1 | 7 |
| 2017 January | 17 | 5 | 22 |
| 2016 December | 44 | 14 | 58 |
| 2016 November | 27 | 6 | 33 |
| 2016 October | 41 | 5 | 46 |
| 2016 September | 24 | 2 | 26 |
| 2016 August | 17 | 5 | 22 |
| 2016 July | 14 | 5 | 19 |
| 2016 June | 0 | 13 | 13 |
| 2016 May | 0 | 14 | 14 |
| 2016 April | 1 | 0 | 1 |
| 2016 March | 3 | 10 | 13 |
| 2016 February | 4 | 0 | 4 |
| 2016 January | 1 | 0 | 1 |
| 2015 December | 6 | 0 | 6 |
| 2015 October | 2 | 0 | 2 |
| 2015 September | 1 | 0 | 1 |
| 2015 August | 1 | 4 | 5 |
| 2015 July | 14 | 6 | 20 |
| 2015 June | 15 | 10 | 25 |
| 2015 May | 38 | 26 | 64 |
| 2015 April | 24 | 37 | 61 |
| 2015 March | 24 | 23 | 47 |
| 2015 February | 31 | 18 | 49 |
| 2015 January | 40 | 21 | 61 |
| 2014 December | 23 | 19 | 42 |
| 2014 November | 18 | 21 | 39 |
| 2014 October | 19 | 24 | 43 |
| 2014 September | 12 | 12 | 24 |
| 2014 August | 24 | 16 | 40 |
| 2014 July | 18 | 14 | 32 |
| 2014 June | 47 | 10 | 57 |
| 2014 May | 42 | 11 | 53 |
| 2014 April | 32 | 6 | 38 |
| 2014 March | 45 | 15 | 60 |
| 2014 February | 42 | 9 | 51 |
| 2014 January | 30 | 6 | 36 |
| 2013 December | 29 | 9 | 38 |
| 2013 November | 24 | 8 | 32 |
| 2013 October | 29 | 9 | 38 |
| 2013 September | 41 | 17 | 58 |
| 2013 August | 23 | 12 | 35 |
| 2013 July | 33 | 8 | 41 |
| 2013 June | 35 | 11 | 46 |
| 2013 May | 28 | 11 | 39 |
| 2013 April | 25 | 7 | 32 |
| 2013 March | 21 | 10 | 31 |
| 2013 February | 26 | 10 | 36 |
| 2013 January | 19 | 5 | 24 |
| 2012 December | 22 | 5 | 27 |
| 2012 November | 12 | 9 | 21 |
| 2012 October | 5 | 4 | 9 |
| 2012 September | 10 | 3 | 13 |
| 2012 July | 1 | 0 | 1 |
| 2012 June | 2 | 0 | 2 |
| 2012 May | 3 | 0 | 3 |
| 2012 April | 9 | 0 | 9 |
| 2012 March | 2 | 0 | 2 |
| 2012 February | 3 | 0 | 3 |
| 2012 January | 2 | 0 | 2 |
| 2011 December | 3 | 0 | 3 |
| 2011 November | 4 | 0 | 4 |
| 2011 October | 2 | 0 | 2 |
| 2011 September | 4 | 0 | 4 |
| 2011 August | 3 | 0 | 3 |
| 2011 July | 8 | 0 | 8 |
| 2011 June | 13 | 0 | 13 |
| 2011 May | 4 | 0 | 4 |
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