Identifying factors associated with concordance with the American College of Rheumatology rheumatoid arthritis treatment recommendations.
BACKGROUND
Factors associated with care concordant with the American College of Rheumatology (ACR) recommendations for the use of disease-modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis (RA) are unknown.


METHODS
We identified a national cohort of biologic-naive patients with RA with visits between December 2008 and February 2013. Treatment acceleration (initiation or dose escalation of biologic and nonbiologic DMARDs) in response to moderate to high disease activity (using the Clinical Disease Activity Index) was assessed. The population was divided into two subcohorts: (1) methotrexate (MTX)-only users and (2) multiple nonbiologic DMARD users. In both subcohorts, we compared the characteristics of patients who received care consistent with the ACR recommendations (e.g., prescriptions for treatment acceleration) and their providers with the characteristics of those who did not at the conclusion of one visit and over two visits, using logistic regression and adjusting for clustering of patients by rheumatologist.


RESULTS
Our study included 741 MTX monotherapy and 995 multiple nonbiologic DMARD users cared for by 139 providers. Only 36.2 % of MTX monotherapy users and 39.6 % of multiple nonbiologic DMARD users received care consistent with the recommendations after one visit, which increased over two visits to 78.3 % and 76.2 %, respectively (25-30 % achieved low disease activity by the second visit without DMARD acceleration). Increasing time since the ACR publication on RA treatment recommendations was not associated with improved adherence.


CONCLUSIONS
Allowing two encounters for treatment acceleration was associated with an increase in care concordant with the recommendations; however, time since publication was not.
Department of Medicine, University of Massachusetts Medical School, AC7-201, 55 Lake Avenue North, Worcester, MA, 01655, USA. lharrold@corrona.org.
Leslie R
LR
Harrold
Department of Medicine, University of Massachusetts Medical School, AC7-201, 55 Lake Avenue North, Worcester, MA, 01655, USA.|Corrona, LLC, Southborough, MA, USA.
George W
GW
Reed
Albany Medical College and The Center for Rheumatology, Albany, NY, USA.
Joel M
JM
Kremer
University of Alabama at Birmingham, Birmingham, AL, USA.
Jeffrey R
JR
Curtis
Brigham and Women's Hospital, Boston, MA, USA.
Daniel H
DH
Solomon
University of Maryland School of Medicine, Baltimore, MD, USA.
Marc C
MC
Hochberg
University of California San Diego, La Jolla, CA, USA.
Arthur
A
Kavanaugh
Corrona, LLC, Southborough, MA, USA.
Katherine C
KC
Saunders
Corrona, LLC, Southborough, MA, USA.
Ying
Y
Shan
New York University School of Medicine, New York, NY, USA.
Tanya M
TM
Spruill
Corrona, LLC, Southborough, MA, USA.|Columbia University, New York, NY, USA.
Dimitrios A
DA
Pappas
Corrona, LLC, Southborough, MA, USA.|New York University School of Medicine, New York, NY, USA.
Jeffrey D
JD
Greenberg
D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000706:statistics & numerical data; D012042:Registries; D012219:Rheumatology / Q000592:standards* / Q000706:statistics & numerical data; D014481:United States
D018501:Antirheumatic Agents
American College of Rheumatology; Disease-modifying antirheumatic drugs; Rheumatoid arthritis