title: Effectiveness of a clinical practice intervention in early rheumatoid arthritis.
abstract: OBJECTIVE
  To compare the outcome of early rheumatoid arthritis (RA) patients in a country where early clinics were established versus the outcome of patients in nonprotocolized clinics.
  
  
  METHODS
  We compared 2 multicenter cohorts: an RA cohort derived from an early arthritis registry set in 36 reference hospitals in which a specific intervention was established (Evaluation of a Model for Arthritis Care in Spain [SERAP]), and a historical control cohort of patients with early RA attending 34 rheumatology departments (Prognosis in Rheumatoid Arthritis [PROAR] cohort). Effectiveness was tested by comparing the change in the Disease Activity Score in 28 joints (DAS28), the change in the Health Assessment Questionnaire (HAQ), and the change in the Sharp/van der Heijde radiologic score using marginal structural models.
  
  
  RESULTS
  A total of 161 early RA patients were recruited in the PROAR cohort and 447 in the SERAP cohort. Being a SERAP patient was inversely correlated with activity, resulting in a decrease of -0.24 (95% confidence interval [95% CI] -0.39, -0.08) units in the population average of the DAS28 after adjustment was made. Moreover, intervention may be seen as a protective factor of radiologic damage, with a decrease of -0.05 (95% CI -0.09, -0.01) units in the logarithm of the total Sharp/van der Heijde score. On the other hand, a decrease in functional impairment was detected, but intervention was not statistically associated with HAQ changes.
  
  
  CONCLUSIONS
  Preventing major radiographic progression in a 2-year term inside structured and organized special programs for the management of disease, such as early arthritis clinics, are effective compared to nonprotocolized referrals, treatment, and followup.
authors: Sociedad Española de Reumatología, Madrid, Spain.
authors: Miguel Ángel
authors: MÁ
authors: Descalzo
authors: Jordi
authors: J
authors: Carbonell
authors: Isidoro
authors: I
authors: González-Álvaro
authors: Raimon
authors: R
authors: Sanmartí
authors: Alejandro
authors: A
authors: Balsa
authors: Valentín
authors: V
authors: Hernandez-Barrera
authors: José Andrés
authors: JA
authors: Román-Ivorra
authors: José
authors: J
authors: Ivorra-Cortés
authors: Pilar
authors: P
authors: Lisbona
authors: Mercedes
authors: M
authors: Alperi
authors: Rodrigo
authors: R
authors: Jiménez-Garcia
authors: Loreto
authors: L
authors: Carmona
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000188:drug therapy*; D001175:Arthrography; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D011379:Prognosis; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents