Skip to main content

Main menu

  • Home
  • Content
    • First Release
    • Current
    • Archives
    • Collections
    • Audiovisual Rheum
    • COVID-19 and Rheumatology
  • Resources
    • Guide for Authors
    • Submit Manuscript
    • Payment
    • Reviewers
    • Advertisers
    • Classified Ads
    • Reprints and Translations
    • Permissions
    • Meetings
    • FAQ
    • Policies
  • Subscribers
    • Subscription Information
    • Purchase Subscription
    • Your Account
    • Terms and Conditions
  • About Us
    • About Us
    • Editorial Board
    • Letter from the Editor
    • Duncan A. Gordon Award
    • Privacy/GDPR Policy
    • Accessibility
  • Contact Us
  • JRheum Supplements
  • Services

User menu

  • My Cart
  • Log In

Search

  • Advanced search
The Journal of Rheumatology
  • JRheum Supplements
  • Services
  • My Cart
  • Log In
The Journal of Rheumatology

Advanced Search

  • Home
  • Content
    • First Release
    • Current
    • Archives
    • Collections
    • Audiovisual Rheum
    • COVID-19 and Rheumatology
  • Resources
    • Guide for Authors
    • Submit Manuscript
    • Payment
    • Reviewers
    • Advertisers
    • Classified Ads
    • Reprints and Translations
    • Permissions
    • Meetings
    • FAQ
    • Policies
  • Subscribers
    • Subscription Information
    • Purchase Subscription
    • Your Account
    • Terms and Conditions
  • About Us
    • About Us
    • Editorial Board
    • Letter from the Editor
    • Duncan A. Gordon Award
    • Privacy/GDPR Policy
    • Accessibility
  • Contact Us
  • Follow jrheum on Twitter
  • Visit jrheum on Facebook
  • Follow jrheum on LinkedIn
  • Follow jrheum on YouTube
  • Follow jrheum on Instagram
  • Follow jrheum on RSS
Research ArticleArticle

Emerging Issues in Pharmacological Management of Rheumatoid Arthritis: Results of a National Needs Assessment Survey Identifying Practice Variations for the Development of Canadian Rheumatology Association Clinical Practice Recommendations

VIVIAN P. BYKERK, ORIT SCHIEIR, POONEH AKHAVAN, GLEN S. HAZLEWOOD, CARLY K. CHENG and CLAIRE BOMBARDIER
The Journal of Rheumatology August 2012, 39 (8) 1555-1558; DOI: https://doi.org/10.3899/jrheum.110208
VIVIAN P. BYKERK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: vbykerk@mtsinai.on.ca
ORIT SCHIEIR
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
POONEH AKHAVAN
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
GLEN S. HAZLEWOOD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
CARLY K. CHENG
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
CLAIRE BOMBARDIER
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • References
  • PDF
  • eLetters
PreviousNext
Loading

Article Figures & Data

Tables

    • View popup
    Table 1.

    2007 Canadian practice patterns for pharmacological management of RA (N = 164).

    Questionnaire ItemsMode (%)Commonly Reported Strategies (%)Comments
    General
      Targets/outcomes used to guide treatment decisionsSwollen joint count (94)Morning stiffness (81), radiographs (80), tender joint count (80), ESR/CRP (76), patient global (65), HAQ (52)42% use gestalt; 28% use DAS28: < 5% use other composite measures such as ACR score, CDAI, or SDAI
      Starting therapy*
      Scenario: New DMARD-naive patient (RF+, 6 SJC, 9 TJC)MTX up to 20–25 mg (53)HCQ + MTX (45), HCQ + SSZ + MTX (21)5% start HCQ alone; < 5% start MTX + LEF; < 3% start MTX + biologic; < 2.5% start SSZ alone
      Frequency of radiographsAnnual (49)Every 6 mo 1 st yr then annual (16); annual until progression stops (11)5% obtain only if treatment changed; < 5% obtain every 6 mo until progression stops; 14% reported “other”
      Obtain MRI/US
      Scenario: New RA patient with normal radiographsMRI: No (49); US: No (64)MRI: Yes (37); US: Yes (24)MRI: 14% reported “unsure”; US: 12% reported “unsure”
    Treatment with corticosteroids
      a. Situations in which believe prednisone should be used in RATemporary bridge for ≤ 12 wks (63)In whom no other options exists; longterm at lowest possible dose (23)6% considered as a DMARD; 5% hardly use due to risk/benefit ratio; 3% only use with systemic features
      b. Treatment strategy
      Scenario: New RA patient 7–10 SJC
    IM or IA (44)Start prednisone 10 mg daily (30); start prednisone 5–10 mg daily (16)5% don’t use prednisone; 5% use 10 mg daily > 6 mo
    Treatment with MTX
      a. Starting dose (per wk)15 mg (51)10 mg (30); 20 mg (9)< 5% start with dose < 10 mg; 3% start with dose > 20 mg
      b. Maximum dose (per wk)25 mg (84)20 mg (9)6% reported max dose of 30 mg; 1% reported max dose > 30 mg
      c. Timing for escalation10–12 wks (25)5/6 wks (22); 4 wks (17); 7/8 wks (16)10% escalate within < 4 wks; 10% escalate within 13–26 wks
      d. Use of subcutaneous (sc) MTXFrequently (56)Occasionally (26); if dose > 15 mg (18)1% reported “never”.
    Reasons for using sc MTX: to improve absorption, reduce side effects, and better effectiveness. Reasons for NOT using sc MTX: patient refusal and no time to teach it
      e. Investigations prior to starting*CBC (100); creatinine (99); ALT (96) AST (91); ESR (90)CRP (84); albumin (82); ALP (76); hepatitis B/C serology (69); chest radiograph (60)43% would order a pregnancy test; 38% would order bilirubin; 10% would order TB skin
      f. Investigations for monitoring*CBC (99); ALT (93); AST (86)Creatinine (79); Alb (65); ALP (54)48% would order ESR; 38% would order CRP
      g. Frequency of monitoringEvery 4 wks (52)Every 6 or 8 wks (41)Every 12 wks (6%)
      h. Situations to suspend therapy*Female attempting conception (98)Bacterial infection requiring antibiotics (78); zoster (71)81% suspend > 3 mo prior to female attempting conception; 76% suspend in male with partner attempting conception; 40% do NOT suspend prior to surgery
    i. MTX combinations agreed are safe and effective to use*MTX + ETN (90); MTX + ADA (88); MTX + INF (87)MTX + SSZ + HCQ (83); MTX + ABAT (62); MTX + RTX (56)37% agree that MTX + LEF is safe and effective to use
    Treatment with biologics
      a. When to start anti-TNF
      Scenario: Patient with moderate to severe RA (assuming no access issues)
    After failure 3–6 mo MTX + HCQ + SSZ (33)After failure 3–6 mo MTX 20–25 mg (31)16% start immediately; 14% start after failure of MTX + LEF; 6% reported “other”
      b. Factors rated as somewhat and very important when initiating a biologic*Effectiveness (99); safety (98); halt radiographic progression (96)Patient preference (87); reimbursement (86)54% rated mechanism of action
      c. Biologic side effects warn patients about*Pneumonia or serious infections (98); TB (96); site reactions (90)Lymphoma (82); opportunistic infections (72); demyelinating disease (61); congestive heart failure (36); lupus-like reactions (34); solid malignancies (34); traveling to TB endemic area (23)After an initial discussion, 30%, 66% and 4% always, occasionally, and never warn patients about biologic side effects, respectively
      d. Strategy after failure of anti-TNF*
      Scenario 1: Failure of anti-TNF+ MTX and flare of 4+ joints after 2 visits (assuming no access issues)
    2nd anti-TNF + MTX (68)ABAT + MTX (21); RTX + MTX (16)5% reported “other”
      e. Treatment with RTX
      When to provide next set of 3 infusionsBeginning to flare (73)After 6 mo (15); after 9 mo (10)2% provide next infusions at full flare; 43% would retreat with a minimal first response to get a better response
    F. Reason to switch biologics*SJC > 5 (70)Radiographic progression (45); SJC > 10 (36); DAS28 (36); patient decides therapy is not effective (33)Switches based on response with composite measures: DAS28 > 3.2 (21%); DAS28 > 2.6 (15%); SDAI > 11 or CDAI > 10 (< 5%); 29% would not switch therapy if patient is substantially better than when they first started the biologic regardless of disease activity
    • ↵* Can provide more than 1 answer. ACR: American College of Rheumatology; CDAI: Clinical Disease3 Activity Index; SDAI: Simplified Disease Activity Index; HAQ: Stanford Health Assessment Questionnaire; SJC: swollen joint count; TJC: tender joint count; MTX: methotrexate; HCQ: hydroxychloroquine; SSZ: sulfasalazine; LEF: leflunomide; CBC: complete blood cell count; ALT: alanine aminotransferase; ALP: alkaline phosphatase; AST: aspartate aminotransferase; ESR: erythrocyte sedimentation rate; CRP: C-reactive protein; ETN: etanercept; ADA: adalimumab; ABAT: abatacept; IM: intramuscular; IA: intraarticular; TB: tuberculosis.

PreviousNext
Back to top

In this issue

The Journal of Rheumatology
Vol. 39, Issue 8
1 Aug 2012
  • Table of Contents
  • Table of Contents (PDF)
  • Index by Author
  • Editorial Board (PDF)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word about The Journal of Rheumatology.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Emerging Issues in Pharmacological Management of Rheumatoid Arthritis: Results of a National Needs Assessment Survey Identifying Practice Variations for the Development of Canadian Rheumatology Association Clinical Practice Recommendations
(Your Name) has forwarded a page to you from The Journal of Rheumatology
(Your Name) thought you would like to see this page from the The Journal of Rheumatology web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Emerging Issues in Pharmacological Management of Rheumatoid Arthritis: Results of a National Needs Assessment Survey Identifying Practice Variations for the Development of Canadian Rheumatology Association Clinical Practice Recommendations
VIVIAN P. BYKERK, ORIT SCHIEIR, POONEH AKHAVAN, GLEN S. HAZLEWOOD, CARLY K. CHENG, CLAIRE BOMBARDIER
The Journal of Rheumatology Aug 2012, 39 (8) 1555-1558; DOI: 10.3899/jrheum.110208

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero

 Request Permissions

Share
Emerging Issues in Pharmacological Management of Rheumatoid Arthritis: Results of a National Needs Assessment Survey Identifying Practice Variations for the Development of Canadian Rheumatology Association Clinical Practice Recommendations
VIVIAN P. BYKERK, ORIT SCHIEIR, POONEH AKHAVAN, GLEN S. HAZLEWOOD, CARLY K. CHENG, CLAIRE BOMBARDIER
The Journal of Rheumatology Aug 2012, 39 (8) 1555-1558; DOI: 10.3899/jrheum.110208
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
Bookmark this article

Jump to section

  • Article
    • Abstract
    • MATERIALS AND METHODS
    • RESULTS
    • DISCUSSION
    • Footnotes
    • REFERENCES
  • Figures & Data
  • Info & Metrics
  • References
  • PDF
  • eLetters

Related Articles

Cited By...

More in this TOC Section

  • Comparative Effectiveness of BNT162b2 and mRNA-1273 Vaccines Against COVID-19 Infection Among Patients With Systemic Autoimmune Rheumatic Diseases on Immunomodulatory Medications
  • Clinimetric Validation of the Assessment of Spondyloarthritis International Society Health Index in Patients With Radiographic Axial Spondyloarthritis in Ixekizumab Trials
  • Sex-Specific Differences in Patients With Psoriatic Arthritis: A Systematic Review
Show more Articles

Similar Articles

Content

  • First Release
  • Current
  • Archives
  • Collections
  • Audiovisual Rheum
  • COVID-19 and Rheumatology

Resources

  • Guide for Authors
  • Submit Manuscript
  • Author Payment
  • Reviewers
  • Advertisers
  • Classified Ads
  • Reprints and Translations
  • Permissions
  • Meetings
  • FAQ
  • Policies

Subscribers

  • Subscription Information
  • Purchase Subscription
  • Your Account
  • Terms and Conditions

More

  • About Us
  • Contact Us
  • My Alerts
  • My Folders
  • Privacy/GDPR Policy
  • RSS Feeds
The Journal of Rheumatology
The content of this site is intended for health care professionals.
Copyright © 2022 by The Journal of Rheumatology Publishing Co. Ltd.
Print ISSN: 0315-162X; Online ISSN: 1499-2752
Powered by HighWire