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
. 2025 Jun 1;64(6):3379-3387.
doi: 10.1093/rheumatology/keae717.

Association of patient- and hospital-level predictors with patterns of initial treatment in patients with rheumatoid arthritis: findings from a national cohort study

Zijing Yang  1 , Edward Alveyn  1 , Mark Russell  1 , Katie Bechman  1 , Callum Coalwood  2 , Elizabeth Price  3 , Abhishek Abhishek  4 , Sam Norton  5 , James Galloway  1
Affiliations

Association of patient- and hospital-level predictors with patterns of initial treatment in patients with rheumatoid arthritis: findings from a national cohort study

Zijing Yang et al. Rheumatology (Oxford). .

Abstract

Objectives: To update the first-line conventional synthetic DMARDs (csDMARDs) prescribing pattern, describe change and variation across demographical and geographical factors in the RA population, and identify individual and hospital factors associated with it.

Methods: This retrospective cohort study included newly diagnosed RA adult patients from 1 May 2018 to 1 April 2023 in the UK. We used adjusted multinomial logistic regression with random effect to explore associations with different first-line csDMRAD prescription and to account for hospital-level clustering.

Results: We identified 15 462 RA patients who received csDMARD treatment. Overall, 57% received MTX monotherapy and 14% received MTX combination therapy as first-line treatment. MTX is the most frequently medication, following by HCQ and SSZ. Compared with non-MTX prescription, prescription of MTX monotherapy [adjusted odds ratio (aOR) 1.25 95% CI (1.22-1.29)] and MTX combination therapy [aOR 1.45 (1.38-1.52)] was significantly higher in patients with higher DAS28, but lower in the non-White individuals with comorbidities: lung disease, cancer, fracture and heart attack. Among those who received MTX, monotherapy is more likely be prescribed in patients with higher DAS28 [aOR 1.08 (1.05-1.11)] and without lung disease [aOR 0.5 (0.44-0.56)], compared with combination therapy. Around 20% of the variability in first-line csDMARD prescribing was attributed to the hospital level.

Conclusion: In this cohort study of new-onset RA population, both individual- and institution-level variation in first-line csDMARD treatment strategy was evident. Gender, ethnicity, disease activity, and comorbidities, especially lung disease, were associated with disparities at the individual level.

Keywords: conventional synthetic disease-modifying antirheumatic drugs; methotrexate; rheumatoid arthritis; treatment strategy.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Trends of first-line conventional synthetic DMARD choice
Figure 2.
Figure 2.
csDMARD strategy stratified by age and gender in RA patients with csDMARDs. csDMARD: conventional synthetic DMARD
Figure 3.
Figure 3.
Forest plot summarizing the age-adjusted ORs for patient-level factors and MTX prescription compared with other conventional synthetic DMARD prescription. OR: odds ratio
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Wong JB, Ramey DR, Singh G. Long-term morbidity, mortality, and economics of rheumatoid arthritis. Arthritis Rheum 2001;44:2746–9. - PubMed
    1. Black RJ, Cross M, Haile LM et al. Global, regional, and national burden of rheumatoid arthritis, 1990–2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol 2023;5:e594–610. - PMC - PubMed
    1. Finckh A, Liang MH, van Herckenrode CM, de Pablo P. Long-term impact of early treatment on radiographic progression in rheumatoid arthritis: a meta-analysis. Arthritis Care Res 2006;55:864–72. - PubMed
    1. Nell VPK, Machold KP, Eberl G et al. Benefit of very early referral and very early therapy with disease-modifying anti-rheumatic drugs in patients with early rheumatoid arthritis. Rheumatology 2004;43:906–14. - PubMed
    1. Niemantsverdriet E, Dougados M, Combe B, van der Helm-van Mil AHM. Referring early arthritis patients within 6 weeks versus 12 weeks after symptom onset: an observational cohort study. Lancet Rheumatol 2020;2:e332–8. - PubMed

Grants and funding