title: Diagnosis and treatment of rheumatoid arthritis in the Emilia Romagna region: a prospective population-based study.
abstract: OBJECTIVE
  To perform a population-based study in rheumatoid arthritis (RA) patients, in order to evaluate the efficacy and safety of pharmacologic treatments.
  
  
  METHODS
  1087 patients with RA were enrolled; inclusion criteria were: newly diagnosed RA, already diagnosed RA with high disease activity (HDA) (DAS28≥4.2) starting biologic DMARDs (bDMARDs), already diagnosed RA with HDA continuing with conventional DMARDs (cDMARDs). The following data were collected: demographics, clinical and laboratory features, imaging and prescribed drugs. All parameters except immunology and imaging (performed yearly) were repeated at each follow-up evaluations (after 3, 6 and 12 months, and thereafter every 12 months). In order to evaluate clinical response, the EULAR response criteria were used as the gold standard.
  
  
  RESULTS
  414 (38.1%) newly diagnosed patients with RA, 477 (43.9%) RA patients who started bDMARDs and 196 (18.0%) RA patients who continued with cDMARDs were enrolled from April 2012 to March 2015 at 12 Rheumatology Centres in the Emilia Romagna Region. Statistical analyses showed a relative risk ratio (RRR) for moderate response of 1.65 in RA patients who started bDMARDs (p=0.16) and 2.49 for newly diagnosed RA (p=0.01). Sex, age and Health Assessment Questionnaire were not statistically significant. A RRR of 2.00 has been confirmed for RA patients who started bDMARDs (p<0.0005) for a good response as well as 2.20 for newly diagnosed RA (p<0.0005). An increase in adverse events among bDMARDs was found, but when looking at infections or neoplasia, no differences were highlighted between RA which started bDMARDs and RA who continued with cDMARDs.
  
  
  CONCLUSIONS
  Our results are in line with already published papers from British and Swedish Registries: a greater likelihood to have a good response is demonstrated for not longstanding RA starting cDMARDs or RA with HDA when a bDMARD is started. Also a good safety profile is demonstrated.
authors.affiliation: Rheumatology Unit, Department of Internal Medicine, Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy. olga.addimanda@ior.it.
authors.forename: Olga
authors.initials: O
authors.lastname: Addimanda
authors.affiliation: Agenzia Sanitaria e Sociale Regionale, Regione Emilia Romagna, Bologna, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Marino
authors.affiliation: Dipartimento Medico Specialistico di Reumatologia, Arcispedale Sant'Anna, Azienda Ospedaliero-Universitaria di Ferrara, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Farina
authors.affiliation: Ambulatorio di Reumatologia, Unità Operativa di Medicina Interna, Policlinico S. Orsola-Malpighi, Azienda Ospedaliero-Universitaria di Bologna, Italy.
authors.forename: Marica
authors.initials: M
authors.lastname: Trevisani
authors.affiliation: Servizio di Reumatologia, Medicina ERI, Azienda Ospedaliera di Piacenza, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Arrigoni
authors.affiliation: SC Reumatologia, Dipartimento di Medicine, Medicina d'Urgenza e Specialità Mediche, Azienda Ospedaliero-Universitaria di Modena, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Lumetti
authors.affiliation: SSD Medicina e Reumatologia, Istituto Ortopedico Rizzoli, Bologna, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Crescentini
authors.affiliation: Servizio di Reumatologia, Azienda USL di Cesena, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Sambo
authors.affiliation: Servizio di Reumatologia, Azienda USL di Rimini, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Bezzi
authors.affiliation: Servizio di Reumatologia, Azienda USL di Forlì, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Bruschi
authors.affiliation: UO Medicina Interna e Reumatologia, Azienda Ospedaliero-Universitaria di Parma, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Santilli
authors.affiliation: Servizio di Reumatologia, Ospedale Maggiore di Bologna, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Reta
authors.affiliation: Servizio di Reumatologia, Ospedale Santa Maria delle Croci, Ravenna, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Bosi
authors.affiliation: UO Medicina Interna e Reumatologia, Azienda Ospedaliero-Universitaria di Parma, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Delsante
authors.affiliation: Servizio di Reumatologia, Azienda USL di Forlì, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Girelli
authors.affiliation: Servizio di Reumatologia, Azienda USL di Cesena, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Montaguti
authors.affiliation: SSD Medicina e Reumatologia, Istituto Ortopedico Rizzoli, Bologna, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Meliconi
authors.affiliation: SC Reumatologia, Dipartimento di Medicine, Medicina d'Urgenza e Specialità Mediche, Azienda Ospedaliero-Universitaria di Modena, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Sebastiani
authors.affiliation: SC Reumatologia, Dipartimento di Medicine, Medicina d'Urgenza e Specialità Mediche, Azienda Ospedaliero-Universitaria di Modena, Italy.
authors.forename: Clodoveo
authors.initials: C
authors.lastname: Ferri
authors.affiliation: Ambulatorio di Reumatologia, Unità Operativa di Medicina Interna, Policlinico S. Orsola-Malpighi, Azienda Ospedaliero-Universitaria di Bologna, Italy.
authors.forename: Nazzarena
authors.initials: N
authors.lastname: Malavolta
authors.affiliation: Dipartimento Medico Specialistico di Reumatologia, Arcispedale Sant'Anna, Azienda Ospedaliero-Universitaria di Ferrara, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Govoni
authors.affiliation: Agenzia Sanitaria e Sociale Regionale, Regione Emilia Romagna, Bologna, Italy.
authors.forename: Susanna
authors.initials: S
authors.lastname: Trombetti
authors.affiliation: Agenzia Sanitaria e Sociale Regionale, Regione Emilia Romagna, Bologna, Italy.
authors.forename: Rossana
authors.initials: R
authors.lastname: De Palma
authors.affiliation: Rheumatology Unit, Department of Internal Medicine, Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Salvarani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D001688:Biological Products / Q000009:adverse effects / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D012042:Registries; D012074:Remission Induction; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products