title: Increasing treatment in early rheumatoid arthritis is not determined by the disease activity score but by physician global assessment: results from the CATCH study.
abstract: OBJECTIVE
  To determine the factors most strongly associated with an increase in therapy of early rheumatoid arthritis (ERA).
  
  
  METHODS
  Data from the Canadian Early Arthritis Cohort (CATCH) were included if the patient had ≥ 2 visits and baseline and 6 months data. A regression analysis was done to determine factors associated with treatment intensification.
  
  
  RESULTS
  Of 1145 patients with ERA, 790 met inclusion criteria; mean age was 53.4 years (SD 14.7), mean disease duration 6.1 months (SD 2.8), 75% were female, baseline Disease Activity Score-28 (DAS28) was 4.7 (SD 1.8) and 2.9 (SD 1.8) at 6 months for included patients. Univariate factors for intensifying treatment were physician global assessment (MDGA; OR 7.8 and OR 7.4 at 3 and 6 months, respectively, p < 0.0005), swollen joint count (SJC; OR 4.7 and OR 7.3 at 3 and 6 months, p < 0.0005), and DAS28 (OR 3.0 and OR 4.6 at 3 and 6 months, p < 0.0005). In the regression model only MDGA was strongly associated with treatment intensification (OR 1.5 and OR 1.2 at 3 and 6 months, p < 0.0005); DAS28 was not consistently predictive (OR 1.0, p = 0.987, and OR 1.2, p = 0.023, at 3 and 6 months). DAS28 was the reason for treatment intensification 2.3% of the time, compared to 51.7% for SJC, 49.9% for tender joint count, and 23.8% for MDGA. For the same SJC, larger joint involvement was more likely to influence treatment than small joints at 3 months (OR 1.4, p = 0.027).
  
  
  CONCLUSIONS
  MDGA was strongly associated with an increase in treatment at 3 and 6 months in ERA, whereas DAS28 was not. Physicians rarely stated that DAS28 was the reason for increasing treatment.
authors.affiliation: Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.
authors.forename: Lonnie
authors.initials: L
authors.lastname: Pyne
authors.forename: Vivian P
authors.initials: VP
authors.lastname: Bykerk
authors.forename: Gilles
authors.initials: G
authors.lastname: Boire
authors.forename: Boulos
authors.initials: B
authors.lastname: Haraoui
authors.forename: Carol
authors.initials: C
authors.lastname: Hitchon
authors.forename: J Carter
authors.initials: JC
authors.lastname: Thorne
authors.forename: Edward C
authors.initials: EC
authors.lastname: Keystone
authors.forename: Janet E
authors.initials: JE
authors.lastname: Pope
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D002170:Canada; D015331:Cohort Studies; D003657:Decision Making; D004185:Disability Evaluation; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians; D011446:Prospective Studies; D012044:Regression Analysis; D012720:Severity of Illness Index
chemical_list: D018501:Antirheumatic Agents