ab22308

Survey of practices regarding management of early rheumatoid arthritis by rheumatologists in France

M. Maravic^1,2, C. Bergé3, J.-P. Daurès3, M.-C. Boissier1

¹Service de Rhumatologie and UPRES 3408, Hôpital Avicenne (APHP) and Université Paris XIII, Bobigny; ²Service de Biostatistique et d'Informatique Médicale, Hôpital Necker Enfants Malades (APHP), Paris; ³Institut Universitaire de Recherche Clinique, Unité de Biostatistique et d'Epidémiologie, Recherche clinique et Economie de santé, Montpellier, France.

ABSTRACT
Objective
To describe the practices of rheumatologists in France regarding the initial management of early rheumatoid arthritis (RA) and to estimate the associated costs.

Methods
A questionnaire on the diagnosis and treatment of early RA was sent to the 2485 practicing rheumatologists in France. The results of the 917 completed questionnaires (37% response rate) were analyzed, and initial investigation and treatment costs, including the first month of treatment, were calculated from a socio-economic perspective.

Results
For the RA diagnosis, more than 80% of the respondents recommended the erythrocyte sedimentation rate, C-reactive protein, complete blood count, rheumatoid factor, antinuclear antibody and wrist radiographs. In 40% and 60% of the cases, antikeratin antibody, liver enzymes, serum creatine, serum protein electrophoresis and radiographs (chest, foot and knee) were advocated. Initial drugs administered were non-steroidal antiinflammatory agents (88%), analgesics (76%), disease modifying anti-rheumatic drugs (74%, with methotrexate in 46% of cases, followed by hydroxychloroquine [13%], sulfasalazine [8%], leflunomide [7%], intramuscular gold therapy [6%]), and glucocorticoids (21%). Rehabilitation was recommended by 51% of the respondents. The median cost for this initial management was Û 273 (mean Û 301, range Û 49-1,336).

Conclusion
Marked variations occur among French rheumatologists in the initial management of early RA. These data may be helpful in identifying obstacles to physiciancompliance with recommendations regarding everyday clinical practice and to set up more a specific evaluative study.

Key words
Rheumatoid arthritis, practices, survey, costs.

This study was funded by Ministère de la Recherche et de la Technologie (UPRES EA-3408), Association Claude Bernard, and, in part, by educational grants from Amgen and Wyeth (France).
Please address correspondence to: Prof. Marie-Christophe Boissier, Service de rhumatologie, Hôpital Avicenne, 125 rue de Stalingrad, 93009 Bobigny cedex, France.
E-mail: marie-christophe.boissier@avc.ap-hop-paris.fr