title: Determining best practices in early rheumatoid arthritis by comparing differences in treatment at sites in the Canadian Early Arthritis Cohort.
abstract: OBJECTIVE
  To determine site variation by comparing outcomes across sites in an early rheumatoid arthritis cohort.
  
  
  METHODS
  Sites from the Canadian Early Arthritis Cohort database with at least 40 patients were studied. Comparisons were made among sites in change in 28-joint Disease Activity Score (DAS28), proportion of patients in DAS28 remission, and treatment strategies.
  
  
  RESULTS
  The study included 1138 baseline patients at 8 sites, with baseline (SD) age 52 years (16.9); 72% women; 23% erosions; 54% ever smokers; 51% rheumatoid factor-positive; 37% anticitrullinated protein antibody-positive; disease duration 187 (203) days; DAS28 4.5 (1.4). Site had an effect on outcomes when adjusting for confounders. At 6 and 12 months, sites B and H, the 2 largest sites, had the best changes in DAS28 (-1.82 and -2.09, respectively, at 6 mos, and -2.27 for both at 12 mos; p < 0.001). Site H had the most patients in DAS28 remission at 6 months [64.5% compared to other sites that had from 34.1% to 51.7% (p < 0.001)], and at the last followup, sites B and H had the most in remission. Subcutaneous methotrexate was used more overall and earlier at sites B and H. Those sites used less steroid therapy, and site B had the second-highest use of triple disease-modifying antirheumatic drugs at any visit. Medications were increased more in 2 of the 3 smallest sites. Biologics were used by 9 months most in the smallest (50.0%) and then largest (19.6%) sites.
  
  
  CONCLUSIONS
  Sites in an early inflammatory arthritis cohort yielded different outcomes. Better outcomes up to 12 months may result from initial treatment with early combination therapy and/or subcutaneous methotrexate.
authors.affiliation: From the Rheumatology Centre, St. Joseph's Health Care, London, Ontario, Canada; the Hospital for Special Surgery, New York, New York, USA; the Arthritis Centre, University of Manitoba, Winnipeg, Manitoba; the University of Toronto, Toronto; Southlake Regional Health Centre, Newmarket, Ontario; the Faculty of Medicine and Health Sciences, Division of Rheumatology, Université de Sherbrooke, Sherbrooke, Quebec; the Rheumatic Disease Unit, Institut de Rhumatologie, Montreal, Quebec; McMaster University, Hamilton, Ontario; and Western University, London, Ontario, Canada.
authors.forename: Jamie A
authors.initials: JA
authors.lastname: Harris
authors.forename: Vivian P
authors.initials: VP
authors.lastname: Bykerk
authors.forename: Carol A
authors.initials: CA
authors.lastname: Hitchon
authors.forename: E C
authors.initials: EC
authors.lastname: Keystone
authors.forename: J Carter
authors.initials: JC
authors.lastname: Thorne
authors.forename: Gilles
authors.initials: G
authors.lastname: Boire
authors.forename: Boulos
authors.initials: B
authors.lastname: Haraoui
authors.forename: Glen
authors.initials: G
authors.lastname: Hazlewood
authors.forename: Ashley J
authors.initials: AJ
authors.lastname: Bonner
authors.forename: Janet E
authors.initials: JE
authors.lastname: Pope
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D002170:Canada; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012074:Remission Induction / Q000379:methods; D012720:Severity of Illness Index; D059039:Standard of Care; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D008727:Methotrexate
keywords: DISEASE PROGRESSION; OUTCOME ASSESSMENT; PROFESSIONAL PRACTICE; REMISSION; RHEUMATOID ARTHRITIS; TREATMENT OUTCOME