title: Patterns of disease modifying antirheumatic drug use in a Spanish cohort of patients with rheumatoid arthritis.
abstract: OBJECTIVE
  To determine the adequacy of disease modifying antirheumatic drug (DMARD) prescription to disease activity in patients with rheumatoid arthritis (RA) and to assess whether the reasons for DMARD discontinuation agree with published evidence.
  
  
  METHODS
  Cross-sectional analysis of the baseline year of a RA cohort (n = 788) randomly selected from the clinical registries of 34 centers. Data about current and previous DMARD use was collected from medical records and confirmed by the patient. Disease activity score (DAS), Health Assessment Questionnaire (HAQ) and Larsen scores, and other clinical data were obtained during the study visit.
  
  
  RESULTS
  At baseline visit, 607 patients (77%) were receiving one or more DMARD. Mean DAS, HAQ, and Larsen scores (+/- SD) were: 3.40 +/- 1.22, 1.6 +/- 0.4, and 54.68 +/- 26.37, respectively. Methotrexate (MTX) was the most frequently prescribed DMARD and parenteral gold salts (GS) showed the highest rate of discontinuation. MTX was used as single therapy in a significantly higher proportion (64.3%) than other DMARD (< 50%) and treatment discontinuation due to inefficacy was significantly less frequent (25.5%) than with other DMARD (> 40%). However, the DAS28 was significantly worse in the group treated with MTX in single therapy than in the group treated with GS alone (4.13 vs 3.43; p = 0.032).
  
  
  CONCLUSIONS
  Despite the high use of DMARD among Spanish patients with RA, a significant number of them still have poor control of the disease. In addition, our data show a different perception of ineffectiveness depending on the DMARD used. A non-systematic use of objective quantitative tools for assessment of RA activity and some non-evidence based decisions on the management of DMARD may account for these findings.
authors.affiliation: Department of Rheumatology, Hospital Universitario de la Princesa, Madrid, Spain. isidoro.ga@eresmas.net
authors.forename: Isidoro
authors.initials: I
authors.lastname: Gonzalez-Alvaro
authors.forename: Loreto
authors.initials: L
authors.lastname: Carmona
authors.forename: Alejandro
authors.initials: A
authors.lastname: Balsa
authors.forename: Raimon
authors.initials: R
authors.lastname: Sanmarti
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Belmonte
authors.forename: Xavier
authors.initials: X
authors.lastname: Tena
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000503:physiopathology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011897:Random Allocation; D012042:Registries; D012720:Severity of Illness Index; D013030:Spain
chemical_list: D018501:Antirheumatic Agents