Delay in initiation of DMARD or anti-inflammatory therapy in patients newly diagnosed with rheumatoid arthritis: An analysis of United States Military Health System TRICARE beneficiaries

Kimsey, Linda; Weissman, Joel S.; Patel, Avni; Drew, Allison; Koehlmoos, Tracey Pérez

doi:10.1016/j.semarthrit.2018.07.003

Cited by 22 publications

(25 citation statements)

References 24 publications

(15 reference statements)

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“…The dotted line represents the mean effect, where the mean and confidence intervals of each study are represented as box and whiskers plots. The total effect is represented by the diamond at the bottom sDMARD therapy in the first year [74][75][76], it is difficult to quantify the significance of this earlier initiation in THA incidence. Another potential contributing factor to the decreasing incidence of THA is a less severe natural course of RA [80,81].…”

Section: Discussionmentioning

confidence: 99%

“…Hence, while there are multiple potential reasons for decreasing THA incidence, a major contributing factor may be the more effective management protocols and treatments that focus on minimising RA disease activity [ 3 , 71 , 72 ]. Specific changes to management protocol include the widespread acceptance of MTX as first-line in the 1990s [ 3 , 71 , 73 ], earlier initiation of sDMARDs from the late 1980s to the mid 2010s [ 3 , 71 , 74 – 76 ], and introduction of bDMARDs in the early to mid 2000s [ 3 , 72 , 77 , 78 ]. Since the time between RA diagnosis and THA is approximately 15 years [ 79 ], the almost 40% decrease decreasing incidence of THA from the 2000s to 2010s is likely the result of changes that occurred in the 2000–2009 decade.…”

Section: Discussionmentioning

confidence: 99%

“…Since the time between RA diagnosis and THA is approximately 15 years [ 79 ], the almost 40% decrease decreasing incidence of THA from the 2000s to 2010s is likely the result of changes that occurred in the 2000–2009 decade. While earlier initiation of sDMARD therapy now results in approximately half of patients with incident RA receiving sDMARD therapy in the first year [ 74 – 76 ], it is difficult to quantify the significance of this earlier initiation in THA incidence. Another potential contributing factor to the decreasing incidence of THA is a less severe natural course of RA [ 80 , 81 ].…”

Section: Discussionmentioning

confidence: 99%

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Incidence and Complication Rates for Total Hip Arthroplasty in Rheumatoid Arthritis: A Systematic Review and Meta-Analysis Across Four Decades

2020

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Introduction: Over the past several decades, management of rheumatoid arthritis (RA) has evolved significantly, but few studies have examined the real-world impact of these changes on orthopaedic surgery in patients with RA. This systematic review assessed total hip arthroplasty (THA) incidence and postoperative complication rates across the past four decades. Methods: This is a systematic literature review sourcing data on THA in patients with RA from the electronic databases MEDLINE, EMBASE,

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Incidence and Complication Rates for Total Hip Arthroplasty in Rheumatoid Arthritis: A Systematic Review and Meta-Analysis Across Four Decades

2020

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“…Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease that affects large and small joints causing bone erosions, joint deformities, and comorbidities [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

The lag time from symptoms onset of rheumatoid arthritis to initiation of Methotrexate: data from the Moroccan register of biotherapies

Eddaoudi¹,

Rostom²,

Hmamouchi³

et al. 2021

Rheumatol Orthop Med

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Objective: The purpose of this study is to determine the time between the onset of rheumatoid arthritis (RA) symptoms and the introduction of methotrexate, as well as the associated factors. Methods:A multicenter cross-sectional study that included data from the Moroccan register of biologic patients with rheumatoid arthritis. Sociodemographic, economic patient data and disease data were collected. A logistic regression was performed to determine the factors that are associated with the change in the delay between the onset of symptoms and the initiation of cDMARD.Results: A total of 225 RA patients were included. The mean age was 51 ± 11 years, with a female predominance of 88% (n=197). The diagnosis lag time was 12 months (12-48). Seventy-three percent of the cases were housewives. Seventy-nine percent of patients received Methotrexate as the first CDMARDS. Salazopyrine was the second prescribed CDMARDS with 7%. Hydroxychloroquine was the third prescribed cDMARDs which 2.2%. The median lag time from symptoms onset to initiation of Methotrexate was 24 months (0.16-71). The factors, associated with the change in the delay between the onset of symptoms and the introduction of methotrexate in univariate analysis, were delay in diagnosis and corticosteroids Taking (p<0.05), only the delay of diagnosis in multivariate analysis persists p=0.0001. Conclusions:Our study suggests that there is a significant delay between diagnosis and the introduction of methotrexate as a first line cDMARDs. In multivariate analysis only the time to diagnosis was associated with the time to start methotrexate.

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“…Сходные данные представили R. Kimsey и соавт. [9], изучавшие спектр препаратов, назначенных 16 680 пациентам с недавно выявленным РА. Установлено, что НПВП получали 42,2%, а опиоиды -35,3% пациентов.…”

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Regular use of non-steroidal anti-inflammatory drugs can effectively control pain and global health in patients with moderate activity of rheumatoid arthritis

Каратеев¹,

Погожева²,

Амирджанова³

et al. 2021

Sovremennaâ revmatologiâ

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Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used to control pain in rheumatoid arthritis (RA). However, many aspects of the therapeutic effect of NSAIDs in RA have not been sufficiently studied. In particular, this concerns the effect of NSAIDs on the inflammatory activity of the disease.Objective: to study the comparative efficacy and safety of NSAIDs in RA patients with moderate and low disease activity.Patients and methods. The study group consisted of 404 patients with RA, 69% women and 31% men, mean age 58.6±10.0 years, with moderate and low disease activity – DAS28<5.1 (mean value 3.7±1.5), who initially had moderate or severe pain: >4 cm on the visual analog scale (VAS) 0–10 cm. All patients received DMARDs, mostly methotrexate 15 to 25 mg weekly, 8.2% biological agents, 18.6% glucocorticoids. All patients were prescribed NSAIDs at the full therapeutic dose. The results of treatment were evaluated after 2 weeks, 1, 3 and 6 months. Criteria of efficacy were the dynamics of pain (10 cm VAS), Patient Global Health (PGH on a 10-cm VAS), the change in the tender joints count (TJC) and swollen joints count(SJC), and dynamics of RA activity (DAS28).Results and discussion. 54.2% of patients received aceclofenac, 19.8% nimesulide, 14.3% meloxicam, 9.1% diclofenac, 2.6% – other NSAIDs. After 2 weeks, the pain decreased from 6.3±1.2 cm to 4.5±1.5 cm on VAS (p<0.001). The severity of pain continued to decrease further, and after 6 months of observation was 4.0±1.2 (p< 001, compared with the baseline level). A similar result was observed for the TJC, SJC, and PGH: the dynamics of these indicators, in comparison with the baseline level, was statistically significant after 2 weeks and after 1, 3, and 6 months of observation (p< 0.05). There was a decrease in the disease activity by DAS28: from 3.7±1.5 to 3.4±1.1 after 3 months (p=0.041) and 3.1±0.9 after 6 months (p=0.02). The effectiveness of aceclofenac and other NSAIDs for pain reduction, TJC, SJC, PGH and DAS28 did not differ. The tolerability of aceclofenac was better than of other NSAIDs: the frequency of dyspepsia after 2 weeks was 23.3% and 36.2% (p=0.004). The frequency of arterial hypertension and edema in patients who used aceclofenac, after 2 weeks and 6 months was slightly lower than in patients treated with other NSAIDs, but the difference was not statistically significant.Conclusion. The use of NSAIDs can effectively control the pain and other symptoms of RA, as well as the disease activity by DAS28 in patients with moderate or low disease activity. Aceclofenac is not inferior to other NSAIDs in analgesic potential and exceeds them in tolerability.

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Delay in initiation of DMARD or anti-inflammatory therapy in patients newly diagnosed with rheumatoid arthritis: An analysis of United States Military Health System TRICARE beneficiaries

Cited by 22 publications

References 24 publications

Incidence and Complication Rates for Total Hip Arthroplasty in Rheumatoid Arthritis: A Systematic Review and Meta-Analysis Across Four Decades

Incidence and Complication Rates for Total Hip Arthroplasty in Rheumatoid Arthritis: A Systematic Review and Meta-Analysis Across Four Decades

The lag time from symptoms onset of rheumatoid arthritis to initiation of Methotrexate: data from the Moroccan register of biotherapies

Regular use of non-steroidal anti-inflammatory drugs can effectively control pain and global health in patients with moderate activity of rheumatoid arthritis

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