title: An effective medical partnership in Nagasaki, Japan for patients with rheumatoid arthritis.
abstract: OBJECTIVE
  A clear division of the roles of inpatient facilities and outpatient clinics treating patients with rheumatoid arthritis (RA) is needed. To address this, we created a medical partnership between a university hospital and 43 community clinics in Nagasaki, Japan.
  
  
  METHODS
  We recruited the clinic physicians and compiled a list of the RA medications used (i.e. methotrexate [MTX], other disease-modifying antirheumatic drugs [DMARDs], and biologics). When a patient's low disease activity or remission was confirmed at the university hospital, the hospital/clinic partnership provided double follow-up/medical care with semiannual meetings between the hospital and clinic physicians.
  
  
  RESULTS
  We enrolled 149 patients who maintained clinical remission at 43 clinics over a 54-month period, without rare serious events. Among the nine patients who returned to the university hospital due to relapse, 66.7% had exacerbated RA within 18 months. An average 8.8-9.6 mg/week (max. 14 mg/week) MTX dose was prescribed at the clinics. The biologic usage rate was 22.1%, with a yearly increase. Among the patients treated with biologics, the DAS28ESR at enrollment was 2.65, with 58% treated with an MTX/biologic combination. A significant reduced number of patients with RA per rheumatologist were observed.
  
  
  CONCLUSIONS
  Maintenance of DAS remission without major adverse events was attained in the medical partnership.
authors.affiliation: a Unit of Translational Medicine, Department of Immunology and Rheumatology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan and.
authors.forename: Hideki
authors.initials: H
authors.lastname: Nakamura
authors.affiliation: a Unit of Translational Medicine, Department of Immunology and Rheumatology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan and.
authors.forename: Naoki
authors.initials: N
authors.lastname: Iwamoto
authors.affiliation: b Department of medical informatics , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Matsumoto
authors.affiliation: a Unit of Translational Medicine, Department of Immunology and Rheumatology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan and.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kawakami
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001688:Biological Products / Q000627:therapeutic use; D005260:Female; D006785:Hospitals, University / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D010317:Partnership Practice / Q000458:organization & administration / Q000592:standards* / Q000706:statistics & numerical data
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products
keywords: Clinic physician; Lodgment institution; Management; Medical partnership; Rheumatoid arthritis