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Methotrexate in Italian patients wiTh Rheumatoid Arthritis (MITRA study): an observational study about the use of methotrexate in early RA patients and the adherence to the EULAR 2013 recommendations. A project of the Italian Society for Rheumatology


1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16

 

  1. Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Italy.
  2. Rheumatology Unit, Department of Emergency and Organ Transplantation (DETO), University of Bari, Italy.
  3. Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Italy. c.montecucco@smatteo.pv.it
  4. Rheumatology, Central Hospital of Bolzano, Italy.
  5. Rheumatology Unit, Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Sapienza University of Rome, AOU Policlinico Umberto I, Rome, Italy.
  6. Rheumatology Unit, Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Sapienza University of Rome, AOU Policlinico Umberto I, Rome, Italy.
  7. Rheumatology Unit, Allergology and Clinical Immunology, University of Rome Tor Vergata, Rome, Italy.
  8. Rheumatology Unit, Mauriziano Hospital, Turin, Italy.
  9. Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliera-Universitaria di Ferrara, Cona, Italy.
  10. Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliera-Universitaria di Ferrara, Cona, Italy.
  11. Epidemiology Unit, Italian Society for Rheumatology, Milan, and Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy.
  12. Epidemiology Unit, Italian Society for Rheumatology, Milan, and Rheumatology Unit, AOU Città della Salute e della Scienza di Torino, Turin, Italy.
  13. Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy.
  14. Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliera-Universitaria di Ferrara, Cona, and Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy.
  15. Rheumatology Unit, Department of Emergency and Organ Transplantation (DETO), University of Bari, Italy.
  16. Division of Clinical Rheumatology, ASST Gaetano Pini-CTO Institute, Milan, Italy; Department of Clinical Sciences and Community Health, Research Center for Adult and Paediatric Rheumatic Diseases, Università degli Studi di Milano, Italy.

CER13752
2021 Vol.39, N°5
PI 1077, PF 1084
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PMID: 33338006 [PubMed]

Received: 29/06/2020
Accepted : 21/09/2020
In Press: 18/12/2020
Published: 31/08/2021

Abstract

OBJECTIVES:
To assess the delay between the disease onset and the beginning of methotrexate (MTX) treatment in RA patients and to evaluate the Italian rheumatologists’ adherence to the EULAR 2013 recommendations.
METHODS:
MITRA is an Italian multicentre observational study carried out on DMARD-naïve RA patients recruited in an 18-month period starting from 2015. The data related to the patients’ characteristics at baseline will be presented.
RESULTS:
332 patients from 13 Italian centres were recruited: the median delay between the onset of symptoms and the beginning of MTX was 197 days (102–431); in 20% of patients a treatment with DMARDs was started within the first 90 days from the onset of symptoms. The clinical target selected was DAS28 remission in 64.2% of cases and low disease activity in 35.8%. Among patients in DAS28 high disease activity, 92.6% received a control visit which was rescheduled within the first 3 months, similarly to those in DAS28 moderate disease activity (91.6%). A DMARD monotherapy was prescribed in 319 patients, while a combined therapy of DMARDs was preferred in 13 cases; 282 patients were treated with MTX. Glucocorticoids were prescribed in 229 patients: the median dosage was of 5 mg (IQR 5–7.5) of prednisone equivalent/day.
CONCLUSIONS:
Diagnostic delay in RA patients continues to be longer than expected. The choice of low disease activity as a target is still very frequent and tight control does not seem to be based on disease activity. This paper offers a realistic and detailed picture of the clinical practice among Italian rheumatologists.

Rheumatology Article