Attitudes to early rheumatoid arthritis: changing patterns. Results of a survey.
OBJECTIVE
To determine if rheumatologists have changed their views on diagnosis and treatment of early rheumatoid arthritis (RA).


METHODS
Three consecutive questionnaires were sent out to international rheumatologists in 1997, 2000, and 2003. The following aspects of early RA were covered: definition; patient referral time; diagnostic means; follow up intervals; and treatment strategies. All initial participants who responded to at least one of the follow up surveys were included in the analysis.


RESULTS
RA is now defined by a smaller number of affected joints (monarthritis: 9.8% respondents in 1997 v 17.4% in 2003), and shorter symptom duration (<3 months: 65.5% in 1997 v 85.8% in 2003). Early referrals (<6 weeks) increased (8.9% in 1997 v 17.4% in 2003). Serological test for diagnosis was mostly rheumatoid factor (100% in 2003), but anti-CCP was already used by 17.4% in 2003. Follow up of patients with early RA intensified (every 2 weeks: 16.1% in 1997 v 30.4% in 2003; every month: 47.8% in 2003 v 64.3% in 1997). Treatment with disease modifying antirheumatic drugs (DMARDs) mainly comprised methotrexate, sulfasalazine, and antimalarial drugs. Leflunomide was among the two favourite DMARDs of 10.9% in 2003, whereas no biological agent was so. In 2003, 46.7% respondents started treatment with DMARDs if RA was suspected (30.9% in 1997); no one waited for erosions to occur (7.3% in 1997).


CONCLUSIONS
The data obtained in this study suggest that the concept of diagnosing and treating RA early is accepted by a large proportion of the rheumatological community.
Aletaha
D
D
Division of Rheumatology, Department of Internal Medicine III, University of Vienna, Vienna General Hospital, Waehringer Guertel 18-20, A-1090 Vienna, Austria. daniel.aletaha@meduniwien.ac.at
Eberl
G
G
Nell
V P K
VP
Machold
K P
KP
Smolen
J S
JS
D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000188:drug therapy*; D001291:Attitude of Health Personnel; D015415:Biomarkers / Q000097:blood; D019538:Health Care Surveys; D006801:Humans; D008134:Long-Term Care / Q000379:methods; D011364:Professional Practice / Q000706:statistics & numerical data / Q000639:trends*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012217:Rheumatoid Factor / Q000097:blood; D012698:Serologic Tests / Q000379:methods; D011795:Surveys and Questionnaires
D018501:Antirheumatic Agents; D015415:Biomarkers; D012217:Rheumatoid Factor