Abstract
Objective. To determine site variation by comparing outcomes across sites in an early rheumatoid arthritis cohort.
Methods. Sites from the Canadian Early Arthritis Cohort database with at least 40 patients were studied. Comparisons were made among sites in change in 28-joint Disease Activity Score (DAS28), proportion of patients in DAS28 remission, and treatment strategies.
Results. The study included 1138 baseline patients at 8 sites, with baseline (SD) age 52 years (16.9); 72% women; 23% erosions; 54% ever smokers; 51% rheumatoid factor-positive; 37% anticitrullinated protein antibody-positive; disease duration 187 (203) days; DAS28 4.5 (1.4). Site had an effect on outcomes when adjusting for confounders. At 6 and 12 months, sites B and H, the 2 largest sites, had the best changes in DAS28 (−1.82 and −2.09, respectively, at 6 mos, and −2.27 for both at 12 mos; p < 0.001). Site H had the most patients in DAS28 remission at 6 months [64.5% compared to other sites that had from 34.1% to 51.7% (p < 0.001)], and at the last followup, sites B and H had the most in remission. Subcutaneous methotrexate was used more overall and earlier at sites B and H. Those sites used less steroid therapy, and site B had the second-highest use of triple disease-modifying antirheumatic drugs at any visit. Medications were increased more in 2 of the 3 smallest sites. Biologics were used by 9 months most in the smallest (50.0%) and then largest (19.6%) sites.
Conclusion. Sites in an early inflammatory arthritis cohort yielded different outcomes. Better outcomes up to 12 months may result from initial treatment with early combination therapy and/or subcutaneous methotrexate.
- RHEUMATOID ARTHRITIS
- REMISSION
- DISEASE PROGRESSION
- TREATMENT OUTCOME
- OUTCOME ASSESSMENT
- PROFESSIONAL PRACTICE
Footnotes
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The Canadian Early Arthritis Cohort (CATCH) study was supported initially by Amgen Canada Inc. and Pfizer Canada Inc. through an unrestricted research grant. As of 2011, further support was provided by Hoffmann-La Roche Ltd., United Chemicals of Belgium Canada Inc., Bristol-Myers Squibb Canada Co., Abbott Laboratories Ltd., and Janssen Biotech Inc. (a wholly owned subsidiary of Johnson & Johnson Inc.). The study was designed and implemented by the investigators. Jamie Harris received The Arthritis Society/Canadian Arthritis Network Summer Research Program for Medical and Allied Health Professionals Studentship and a JuMP (Joint Motion Program) Summer Trainee Studentship (Canadian Institutes of Health Research NET training grant).
- Accepted for publication July 19, 2013.