title: Do rheumatologists know best? An outcomes study of inconsistent users of disease-modifying anti-rheumatic drugs.
abstract: OBJECTIVE
  Current recommendations advocate treatment with disease-modifying anti-rheumatic drugs (DMARDs) in all patients with active rheumatoid arthritis (RA). We analyzed short-term disease outcome in patients according to the consistency of DMARD use in a clinical rheumatology cohort.
  
  
  METHODS
  Patients in an RA registry (n = 617) were studied for DMARD use at semi-annual study time points during the first 18 months of follow-up and were divided into 4 groups according to the number of study time points with any DMARD use [0-1 study time points (n = 31), 2 study time points (n = 24), 3 study time points (n = 77), and 4 study time points (n = 485)]. The primary outcome analyses were performed at 24 months and included Disease Activity Score 28 (DAS28-CRP), modified Health Assessment Questionnaire (MHAQ) change, Short Form Health Survey-12 physical and mental summary scores (SF-12 PCS, SF-12 MCS), EuroQol 5-Dimensional health index (EQ-5D), and radiographic progression. Unadjusted, adjusted, and analyses stratified for seropositivity and disease activity were performed. A secondary analysis investigated 36-month outcomes.
  
  
  RESULTS
  No significant 24-month outcome differences could be found between the DMARD use categories. For seropositive patients, there was evidence of a linear trend for SF-12 PCS (p = 0.02) and EQ-5D (p = 0.01) with worse outcomes for inconsistent DMARD users. At 36 months, there was a linear trend for higher DAS28-CRP scores for inconsistent users (p < 0.01).
  
  
  CONCLUSIONS
  Overall, we found poor correlation between inconsistent DMARD use and short-term disease outcome. However, outcome in the longer term could be negatively influenced by inconsistent DMARD use, as well as short-term outcome in seropositive patients.
authors.affiliation: Division of Rheumatology, Immunology and Allergy, Brigham and Women׳s Hospital, Boston, MA; Department of Rheumatology, Diakonhjemmet Hospital, P.O. Box 23 Vinderen 0319, Oslo, Norway. Electronic address: maria_mjaavatten@hotmail.com.
authors.forename: Maria D
authors.initials: MD
authors.lastname: Mjaavatten
authors.affiliation: Division of Rheumatology, Immunology and Allergy, Brigham and Women׳s Hospital, Boston, MA; Department of Internal Medicine III, Medical University Vienna, Vienna, Austria.
authors.forename: Helga
authors.initials: H
authors.lastname: Radner
authors.affiliation: Division of Rheumatology, Immunology and Allergy, Brigham and Women׳s Hospital, Boston, MA; Department of Rheumatology, Kameda Medical Center, Kamogawa, Chiba Prefecture, Japan.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Yoshida
authors.affiliation: Division of Rheumatology, Immunology and Allergy, Brigham and Women׳s Hospital, Boston, MA.
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Shadick
authors.affiliation: Division of Rheumatology, Immunology and Allergy, Brigham and Women׳s Hospital, Boston, MA.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Frits
authors.affiliation: Division of Rheumatology, Immunology and Allergy, Brigham and Women׳s Hospital, Boston, MA.
authors.forename: Christine K
authors.initials: CK
authors.lastname: Iannaccone
authors.affiliation: Department of Rheumatology, Diakonhjemmet Hospital, P.O. Box 23 Vinderen 0319, Oslo, Norway.
authors.forename: Tore K
authors.initials: TK
authors.lastname: Kvien
authors.affiliation: Division of Rheumatology, Immunology and Allergy, Brigham and Women׳s Hospital, Boston, MA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Weinblatt
authors.affiliation: Division of Rheumatology, Immunology and Allergy, Brigham and Women׳s Hospital, Boston, MA; Division of Pharmacoepidemiology, Brigham and Women׳s Hospital, Boston, MA.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Solomon
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D011788:Quality of Life; D012042:Registries; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents
keywords: Disease outcomes; Disease-modifying anti-rheumatic drugs; Drug adherence; Longitudinal study; Rheumatoid arthritis