RT Journal Article
SR Electronic
T1 Determining Best Practices in Early Rheumatoid Arthritis by Comparing Differences in Treatment at Sites in the Canadian Early Arthritis Cohort
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP 1823
OP 1830
DO 10.3899/jrheum.121316
VO 40
IS 11
A1 Jamie A. Harris
A1 Vivian P. Bykerk
A1 Carol A. Hitchon
A1 E.C. Keystone
A1 J. Carter Thorne
A1 Gilles Boire
A1 Boulos Haraoui
A1 Glen Hazlewood
A1 Ashley J. Bonner
A1 Janet E. Pope
YR 2013
UL http://www.jrheum.org/content/40/11/1823.abstract
AB 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.