Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2006 Aug;65(8):1102-5.
doi: 10.1136/ard.2004.027656. Epub 2005 Dec 1.

Trends in disease modifying antirheumatic drug prescription in early rheumatoid arthritis are influenced more by hospital setting than patient or disease characteristics

C Carli  1 , A G C Ehlin, L Klareskog, S Lindblad, S M Montgomery
Affiliations
Comparative Study

Trends in disease modifying antirheumatic drug prescription in early rheumatoid arthritis are influenced more by hospital setting than patient or disease characteristics

C Carli et al. Ann Rheum Dis. 2006 Aug.

Abstract

Objective: To characterise temporal trends and factors associated with the prescription of disease modifying antirheumatic drugs (DMARDs) at the initial consultation in early rheumatoid arthritis (RA).

Methods: Data from 2584 patients with early RA at 19 hospitals were extracted from the Swedish Rheumatoid Arthritis Register for the period 1997-2001. Disease characteristics and DMARD prescription at first consultation with the rheumatologist were investigated using cross tabulation and logistic regression.

Results: DMARD prescriptions, particularly for methotrexate, increased from 1997 to 2001 independently of patient characteristics. Stratification by hospital type showed that patients in district hospitals were less likely to be prescribed DMARDs than those in university hospitals (adjusted odds ratio (OR) = 0.53 (95% confidence interval (CI) 0.40 to 0.69), p<0.001), independently of confounding factors. Association of the DAS28 with the likelihood of DMARD prescription was greater among patients attending district hospitals (OR = 1.65 (1.34 to 2.02), p<0.001) than those at university hospitals (OR = 1.23 (1.07 to 1.41), p = 0.003) and county hospitals (OR = 1.34 (1.01 to 1.63), p = 0.003). Interaction testing indicated that the difference was significant (p = 0.007).

Conclusions: Temporal trends in DMARD prescription indicate an increasingly aggressive approach to disease management among Swedish rheumatologists. However, the association of hospital type with DMARD prescription suggests that the adoption of research findings in clinical care varies considerably.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None.

References

    1. Stenger A A, Van Leeuwen M A, Houtman P M, Bruyn G A, Speerstra F, Barendsen B C.et al Early effective suppression of inflammation in rheumatoid arthritis reduces radiographic progression. Br J Rheumatol 1998371157–1163. - PubMed
    1. Egsmose C, Lund B, Borg G, Petterson H, Berg E, Brodin U.et al Patients with rheumatoid arthritis benefit from early 2nd line therapy: 5 year follow‐up of a prospective double blind placebo controlled study. J Rheumatol 1995122208–2213. - PubMed
    1. van der Heijde D M, Jacobs J W, Bijlsma J W, Heurkens A H, van Booma‐Frankfort, van der Veen M J.et al The effectiveness of early treatment with “second‐line” antirheumatic drugs: a randomised controlled trial. Ann Intern Med 1996124699–707. - PubMed
    1. Mottonen T, Hannonen P, Korpela M, Nissila M, Kautiainen H, Ilonen J.et al Delay to institution of therapy and induction of remission using single‐drug or combination‐disease‐modifying antirheumatic drug therapy in early rheumatoid arthritis. Arthritis Rheum 200246894–898. - PubMed
    1. Criswell L A, Henke C J. What explains the variation among rheumatologists in their use of prednisolone and second line agents for the treatment of rheumatoid arthritis? J Rheumatol 199522829–835. - PubMed

Publication types