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Diagnosis and treatment of rheumatoid arthritis in the Emilia Romagna region: a prospective population-based study

1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24

 

  1. Rheumatology Unit, Department of Internal Medicine, Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy. olga.addimanda@ior.it
  2. Agenzia Sanitaria e Sociale Regionale, Regione Emilia Romagna, Bologna, Italy.
  3. Dipartimento Medico Specialistico di Reumatologia, Arcispedale Sant’Anna, Azienda Ospedaliero-Universitaria di Ferrara, Italy.
  4. Ambulatorio di Reumatologia, Unità Operativa di Medicina Interna, Policlinico S. Orsola-Malpighi, Azienda Ospedaliero-Universitaria di Bologna, Italy.
  5. Servizio di Reumatologia, Medicina ERI, Azienda Ospedaliera di Piacenza, Italy.
  6. SC Reumatologia, Dipartimento di Medicine, Medicina d’Urgenza e Specialità Mediche, Azienda Ospedaliero-Universitaria di Modena, Italy.
  7. SSD Medicina e Reumatologia, Istituto Ortopedico Rizzoli, Bologna, Italy.
  8. Servizio di Reumatologia, Azienda USL di Cesena, Italy.
  9. Servizio di Reumatologia, Azienda USL di Rimini, Italy.
  10. Servizio di Reumatologia, Azienda USL di Forlì, Italy.
  11. UO Medicina Interna e Reumatologia, Azienda Ospedaliero-Universitaria di Parma, Italy.
  12. Servizio di Reumatologia, Ospedale Maggiore di Bologna, Italy.
  13. Servizio di Reumatologia, Ospedale Santa Maria delle Croci, Ravenna, Italy.
  14. UO Medicina Interna e Reumatologia, Azienda Ospedaliero-Universitaria di Parma, Italy.
  15. Servizio di Reumatologia, Azienda USL di Forlì, Italy.
  16. Servizio di Reumatologia, Azienda USL di Cesena, Italy.
  17. SSD Medicina e Reumatologia, Istituto Ortopedico Rizzoli, Bologna, Italy.
  18. SC Reumatologia, Dipartimento di Medicine, Medicina d’Urgenza e Specialità Mediche, Azienda Ospedaliero-Universitaria di Modena, Italy.
  19. SC Reumatologia, Dipartimento di Medicine, Medicina d’Urgenza e Specialità Mediche, Azienda Ospedaliero-Universitaria di Modena, Italy.
  20. Ambulatorio di Reumatologia, Unità Operativa di Medicina Interna, Policlinico S. Orsola-Malpighi, Azienda Ospedaliero-Universitaria di Bologna, Italy.
  21. Dipartimento Medico Specialistico di Reumatologia, Arcispedale Sant’Anna, Azienda Ospedaliero-Universitaria di Ferrara, Italy.
  22. Agenzia Sanitaria e Sociale Regionale, Regione Emilia Romagna, Bologna, Italy.
  23. Agenzia Sanitaria e Sociale Regionale, Regione Emilia Romagna, Bologna, Italy.
  24. Rheumatology Unit, Department of Internal Medicine, Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy.

CER9324
2017 Vol.35, N°2
PI 0201, PF 0208
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PMID: 28134078 [PubMed]

Received: 07/02/2016
Accepted : 26/05/2016
In Press: 27/01/2017
Published: 15/03/2017

Abstract

OBJECTIVES:
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.

Rheumatology Article