title: Comparison of characteristics and therapeutic efficacy in rheumatoid arthritis patients treated by rheumatologists and those treated by orthopedic surgeons under a team medicine approach at the same institute.
abstract: The treatment of rheumatoid arthritis (RA) has improved dramatically with the advent of the latest generation of disease-modifying antirheumatic drugs. Despite these advances, in some patients inflammation is not diminished sufficiently to prevent irreversible musculoskeletal damage, thereby necessitating surgical intervention to reduce pain and improve function. For RA treatment, Japanese orthopedic surgeons also prescribe medication. In this study, we examined whether this Japanese system is effective for RA treatment. We analyzed the clinical condition of RA patients treated by rheumatologists and those treated by orthopedists in a linked registry study using information from a large observational cohort of RA patients followed every half year from 2000 to 2010 (the IORRA cohort). Two groups of patients were compared: patients treated by rheumatologists (rheumatologic group) and patients treated by orthopedists (orthopedic group). The results revealed that patients in the orthopedic group were older, more likely to be female, and had a longer disease duration than patients in the rheumatologic group. The proportion of patients with a history of joint surgery was also much higher in the orthopedic group than in the rheumatologic group. The average scores on the Japanese version of the Health Assessment Questionnaire, and the remission ratio determined using a Boolean-based definition gradually increased from 2000 until 2010, and these findings were consistently better in the rheumatologic group than in the orthopedic group. These data suggest that patients treated primarily by orthopedists are more likely to have long-standing RA compared to patients treated by rheumatologists. Therefore, it is critical for rheumatologists and orthopedists to complement each other medically in the treatment of RA patients.
authors.affiliation: Institute of Rheumatology, Tokyo Women's Medical University, 10-22 Kawada, Shinjuku, Tokyo 162-0054, Japan. smomohara@ior.twmu.ac.jp
authors.forename: Shigeki
authors.initials: S
authors.lastname: Momohara
authors.forename: Eisuke
authors.initials: E
authors.lastname: Inoue
authors.forename: Katsunori
authors.initials: K
authors.lastname: Ikari
authors.forename: Koichiro
authors.initials: K
authors.lastname: Yano
authors.forename: Asami
authors.initials: A
authors.lastname: Tokita
authors.forename: Yurino
authors.initials: Y
authors.lastname: Honjo
authors.forename: Yu
authors.initials: Y
authors.lastname: Sakuma
authors.forename: Ryo
authors.initials: R
authors.lastname: Hiroshima
authors.forename: Takuji
authors.initials: T
authors.lastname: Iwamoto
authors.forename: Yohei
authors.initials: Y
authors.lastname: Seto
authors.forename: Eiichi
authors.initials: E
authors.lastname: Tanaka
authors.forename: Atsuo
authors.initials: A
authors.lastname: Taniguchi
authors.forename: Hisashi
authors.initials: H
authors.lastname: Yamanaka
mesh_terms: D000367:Age Factors; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009985:Orthopedics / Q000379:methods*; D010348:Patient Care Team / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D012074:Remission Induction; D012219:Rheumatology / Q000379:methods*; D012737:Sex Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents