title: A multi-center, observational study shows high proportion of Australian rheumatoid arthritis patients have inadequate disease control.
abstract: OBJECTIVE
  To evaluate the disease activity and current pharmacological interventions used to achieve remission in rheumatoid arthritis (RA) patients in Australia.
  
  
  METHODS
  Rheumatoid arthritis patients treated in participating Australian clinics were included in the study. Patient demographics, disease onset, medications and disease measures were analyzed. Data, de-identified to the patient, clinic and clinician were captured using an electronic clinical management program. The disease activity score (DAS28) was used to classify patients into the disease activity states of remission, low disease activity (LDA), moderate disease activity (MDA) and high disease activity (HDA). Choice of therapy was at the discretion of the treating clinician.
  
  
  RESULTS
  A total of 5686 patients, 72.9% female, 26.9% male, with mean age 61.1 (SD 13.6) years and mean disease duration of 11.5 (SD 10.5) years were analyzed. DAS28 ESR (erythrocyte sedimentation rate) scores were recorded for 2973 patients, with 41.6% in remission, 18.6% LDA, 31.6% MDA and 8.2% HDA. Of those in remission, 17% received a biological disease modifying anti-rheumatic drug (bDMARD), 73% methotrexate (MTX), 19% leflunomide (LEF) and 28% prednisolone. Of the patients with MDA, 20% received a bDMARD, 76% MTX, 24% LEF and 39% prednisolone. Of the patients in HDA, 27% received a bDMARD, 78% MTX, 31% LEF and 60% with prednisolone.
  
  
  CONCLUSIONS
  Cross-sectional assessment of this large cohort of Australian RA patients found a large proportion remain in moderate or high disease activity; suggesting a considerable evidence-practice gap. Improvement in disease control in this group may reduce future health burdens.
authors.affiliation: Monash University and Monash Medical Centre, Clayton, Victoria, Australia.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Littlejohn
authors.forename: Lynden
authors.initials: L
authors.lastname: Roberts
authors.forename: Mark
authors.initials: M
authors.lastname: Arnold
authors.forename: Paul
authors.initials: P
authors.lastname: Bird
authors.forename: Simon
authors.initials: S
authors.lastname: Burnet
authors.forename: Julien
authors.initials: J
authors.lastname: de Jager
authors.forename: Hedley
authors.initials: H
authors.lastname: Griffiths
authors.forename: Dave
authors.initials: D
authors.lastname: Nicholls
authors.forename: James
authors.initials: J
authors.lastname: Scott
authors.forename: Jane
authors.initials: J
authors.lastname: Zochling
authors.forename: Kathleen E
authors.initials: KE
authors.lastname: Tymms
mesh_terms: D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D001315:Australia / Q000453:epidemiology; D001799:Blood Sedimentation; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012074:Remission Induction; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents
keywords: biologic; disease activity; disease-modifying anti-rheumatic drugs; remission; rheumatoid arthritis