Practices for managing a flare of long-standing rheumatoid arthritis: Survey among French rheumatologists

M. Maravic^1,2, C. Bergé³, J.-P. Daurè³, M.-C. Boissier¹

¹Service de Rhumatologie and UPRES 3408, Hôpital Avicenne (APHP) and Université Paris 13, 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 for managing a flare in a patient being treated for long-standing rheumatoid arthritis (RA) and to estimate the corresponding costs.

Methods
A survey questionnaire was sent to the 2485 practicing rheumatologists in France; 917 completed questionnaires were returned (37% response rate). The questionnaire collected information on the respondents and on their recommendations for managing a fictional patient with a 10-year history of RA in flare, with a recent episode of neck pain, despite prednisone and methotrexate therapy. Investigational and treatment (first month) costs were estimated from the perspective of society in 2001 Euros (€).

Results
Over 80% of the respondents recommended measuring laboratory inflammation parameters, complete blood cell counts, liver enzymes, serum creatinine, and radiographs (hands, anteroposterior cervical spine view, wrists, knees); 50-70% recommended additional cervical spine incidences, elbow and chest radiographs, and bone absorptiometry. Adding anti-TNF therapy (24%) or another DMARD (10%), increasing the methotrexate dosage (24%), and substituting leflunomide for methotrexate were the main recommended treatments. Most respondents suggested continuing the glucocorticoid in the same dosage (61%) or a higher dosage (36%). Analgesics and non-steroidal anti-inflammatory drugs were recommended by 65% and 41% of respondents and rehabilitation therapy by 83%. The median cost was €500 (mean €1,105; range €80-4,089).

Conclusion
We found a high level of agreement among French rheumatologists regarding the evaluation of established RA. Marked variations in recommended treatments were observed and translated into major cost differences.

Key words
Rheumatoid arthritis, evaluation, drug prescription, survey.

This work was supported by research funds from the Education Ministry. An educational grant was received from Wyeth-France.
Please address correspondence to: Prof. M.C. Boissier, Service de rhumatologie, Hopital Avicenne, 125 rue de Stalingrad, 93009, Bobigny cedex, France.
E-mail: marie-christophe.boissier@avc.ap-hop-paris.fr

Clin Exp Rheumatol 2005; 23: 36-42.
© CLINICAL AND EXPERIMENTAL RHEUMATOLOGY 2005.