title: How do French rheumatologists treat early rheumatoid arthritis?
abstract: Although factors that appear to predict long-term outcomes of rheumatoid arthritis have been identified, there is no consensus about the treatment early in the disease. To determine how French office- and hospital-based rheumatologists treat early rheumatoid arthritis, we created three clinical vignettes corresponding to different levels of severity of early rheumatoid arthritis (less than six months' disease duration). Cases 1 and 2 were relatively young patients (35 and 50 years), and Case 1 had numerous poor prognosis factors. Case 3 was 80 years of age. Rheumatologists were asked to indicate which medications they would use at presentation and after one year of a favorable or unfavorable course. The study was conducted by questionnaire (response rate, 58%). Of the 185 rheumatologists who completed the questionnaire, 81% were male and 19% female; mean age was 42 +/- 8 years. In Cases 1 and 2, nonsteroidal antiinflammatory drugs were given by 99% of respondents; second-line drugs were prescribed at presentation by 93% of respondents in Case 1 and 86% in Case 2, and methotrexate was more likely to be used in the presence of poor prognosis factors (23% in case 1 and 7% in Case 2). In the event of an unfavorable course after one year, a larger proportion of rheumatologists prescribed glucocorticoid therapy (65% in Case 1 and 20% in Case 2), and there was a shift from "conventional" to "modern" second-line drugs, with more widespread use of methotrexate (65% in case 1 and 18% in case 2). In the 80-year-old patient, glucocorticoid therapy was used more often than nonsteroidal antiinflammatory drugs and second-line drugs (gold salts, hydroxychloroquine, sulfasalazine) were prescribed by 40% of rheumatologists at presentation and by 67% after one year of an unfavorable course; in the latter situation, methotrexate was selected in 24% of cases. In contrast to conventional recommendations, many French office- or hospital-based rheumatologists use second-line drugs very early and base their choice of medications on the estimated risk of severe disease and on the age of the patient.
authors.affiliation: Groupe de Recherche en Immunopathologie (GRIMP), Boisguillaume Hospital, Rouen Teaching Hospital, France.
authors.forename: N
authors.initials: N
authors.lastname: de Asit
authors.forename: X
authors.initials: X
authors.lastname: Le Loët
authors.forename: P
authors.initials: P
authors.lastname: Czernichow
authors.forename: J M
authors.initials: JM
authors.lastname: Bertho
authors.forename: B
authors.initials: B
authors.lastname: Delcambre
authors.forename: F
authors.initials: F
authors.lastname: Tonnel
authors.forename: G
authors.initials: G
authors.lastname: Loyau
authors.forename: C
authors.initials: C
authors.lastname: Dapogny
authors.forename: R
authors.initials: R
authors.lastname: Trèves
authors.forename: J P
authors.initials: JP
authors.lastname: Valat
authors.forename: P
authors.initials: P
authors.lastname: Tauveron
authors.forename: J L
authors.initials: JL
authors.lastname: Sebert
authors.forename: P
authors.initials: P
authors.lastname: Boumier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005602:France; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D012219:Rheumatology / Q000379:methods*; D011795:Surveys and Questionnaires
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D005938:Glucocorticoids