title: How Canadian and US rheumatologists treat moderate or aggressive rheumatoid arthritis: a survey.
abstract: OBJECTIVE
  To determine which second line agents Canadian and US rheumatologists use to treat patients with active rheumatoid arthritis (RA).
  
  
  METHODS
  A one page survey was sent by fax or mail to all 263 members of the Canadian Rheumatology Association and 320 members of the American College of Rheumatology (10% random sample weighted by region) known to practice adult rheumatology. The survey asked for first and second treatment preferences in patients with (1) aggressive RA; (2) moderate RA; and (3) aggressive RA failing a trial of methotrexate (MTX) 25 mg.
  
  
  RESULTS
  Altogether 231 (87.8%) Canadian and 230 (71.7%) US rheumatologists responded, and 214 responses in each survey were analyzable. In aggressive RA. MTX was the drug of first choice of most Canadian (68.7%) and US (78.5%) rheumatologists. Intramuscular gold was a drug of first choice for 14.5 and 1.9% of Canadians and Americans, respectively. 93.9% of Canadian and 90.2% of US respondents preferred single agents for the treatment of moderate RA. Among US rheumatologists. no clear leader emerged as a single agent alternative for the management of aggressive RA unresponsive to MTX. Most said they would use combination (38.3%) or triple (23.8%) therapy involving MTX plus sulfasalazine and/or hydroxychloroquine. 52.3% of Canadians preferred single agent therapy, with 34.6% choosing gold as an alternative to MTX.
  
  
  CONCLUSIONS
  Canadian and US rheumatologists preferred MTX for the treatment of aggressive RA. Canadian rheumatologists saw a small but significant role for intramuscular gold. No single agent emerged as a clear alternative to MTX among US rheumatologists.
authors.affiliation: Healthcare Research Division, Arthritis & Immune Disorder Research Centre, Toronto, Ontario, Canada. maetzel@whri.on.ca
authors.forename: A
authors.initials: A
authors.lastname: Maetzel
authors.forename: C
authors.initials: C
authors.lastname: Bombardier
authors.forename: V
authors.initials: V
authors.lastname: Strand
authors.forename: P
authors.initials: P
authors.lastname: Tugwell
authors.forename: G
authors.initials: G
authors.lastname: Wells
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D002170:Canada; D003625:Data Collection; D011307:Drug Prescriptions; D004359:Drug Therapy, Combination; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use; D010818:Practice Patterns, Physicians'; D012219:Rheumatology; D012460:Sulfasalazine / Q000627:therapeutic use; D014481:United States
chemical_list: D018501:Antirheumatic Agents; D012460:Sulfasalazine; D008727:Methotrexate