title: Most rheumatologists are conservative in active rheumatoid arthritis despite methotrexate therapy: results of the PRISME survey.
abstract: OBJECTIVE
  To evaluate the proportion of patients with rheumatoid arthritis (RA) visiting office-based rheumatologists for persistently active RA despite past or current methotrexate (MTX) treatment, and to describe the management of these patients in France in 2003.
  
  
  METHODS
  All French rheumatologists were invited to participate in a cross-sectional postal survey. During a predetermined week, they were to include the first 2 patients seen for RA with a history of past or current MTX treatment. Adequacy of current treatment was assessed based on the 28-joint Disease Activity Score 28 (DAS28) and on current MTX and corticosteroid regimens.
  
  
  RESULTS
  Of the 1800 French rheumatologists, 492 returned 838 assessable patient questionnaires. Mean patient age was 58 years and mean time since RA diagnosis was 10 years; 77% of patients were currently taking MTX, and 51% a corticosteroid. High dosages were noted for MTX (> 15 mg/week) in 20% of patients and for corticosteroid therapy (> 10 mg/day) in 5%. Nevertheless, 41% of patients had active RA (DAS28 score 3.2 to 5.1) and 7% had very active RA (DAS28 score > 5.1). The treatment was left unchanged in 78% of patients, and biological therapy was contemplated in only 16% of patients.
  
  
  CONCLUSIONS
  Although half of MTX-treated patients with RA visiting office-based rheumatologists had active or very active disease, a change in treatment was rarely considered.
authors.affiliation: Department of Rheumatology, La Cavale Blanche Teaching Hospital, Brest, France. Alain.Saraux@univ-brest.fr
authors.forename: Alain
authors.initials: A
authors.lastname: Saraux
authors.forename: Valérie
authors.initials: V
authors.lastname: Devauchelle-Pensec
authors.forename: Luc
authors.initials: L
authors.lastname: Engerran
authors.forename: René Marc
authors.initials: RM
authors.lastname: Flipo
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D005602:France; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012219:Rheumatology / Q000379:methods*; D011795:Surveys and Questionnaires
chemical_list: D018501:Antirheumatic Agents; D008727:Methotrexate