Department of Rheumatology, Monash Medical Centre/Monash University, Melbourne, Victoria, Australia.
Intern Med J. 2011 Jun;41(6):450-5. doi: 10.1111/j.1445-5994.2010.02240.x. Epub 2010 Apr 12.
Our aim was to examine the spectrum of disease activity and usage of disease-modifying anti-rheumatic drugs (DMARD) in rheumatoid arthritis (RA) patients seen over a period of 12 months in community-based rheumatology practice.
Data were prospectively collected on 1059 consecutive RA patients who attended two private, community-based rheumatology clinics from 1 May 2007 to 1 May 2008. Information on patient demographics, medication history and disease activity was collected. Life table graphs were developed to track medication retention over time. Statistical significance was determined by log-rank tests.
One thousand and fifty-nine patients with RA were entered into the database over a 12-month period. Eight hundred and twenty-six patients (85%) were treated with single or combination conventional DMARD compared with 159 patients (15%) on a biologic DMARD either alone or in combination. Methotrexate monotherapy was the most commonly prescribed DMARD, used in 41% of patients studied. Almost half (47%) were on combination DMARD therapy. Methotrexate and tumour necrosis factor inhibitors had the highest retention rate over 12 and 30 months since first prescription. A large proportion of patients (47%) had moderate disease activity.
Rates of biologic DMARD usage were similar to other studies and the predominance of methotrexate use was also in keeping with current recommendations for management of RA. There appears to be a significant unmet need for improved disease control among RA patients with moderate disease activity, which requires further investigation.
本研究旨在探讨在社区为基础的风湿病诊所中，连续就诊的类风湿关节炎（RA）患者在 12 个月内的疾病活动谱和疾病修饰抗风湿药物（DMARD）的使用情况。
前瞻性收集了 2007 年 5 月 1 日至 2008 年 5 月 1 日期间在两家私人社区为基础的风湿病诊所就诊的 1059 例连续 RA 患者的数据。收集了患者的人口统计学、药物治疗史和疾病活动度信息。采用生存表图来跟踪药物随时间的保留情况。通过对数秩检验确定统计学显著性。
在 12 个月的时间内，共纳入了 1059 例 RA 患者。826 例（85%）患者接受了单一或联合常规 DMARD 治疗，而 159 例（15%）患者单独或联合使用生物 DMARD 治疗。甲氨蝶呤单药治疗是最常用的 DMARD，在研究的 41%患者中使用。近一半（47%）的患者接受了联合 DMARD 治疗。甲氨蝶呤和肿瘤坏死因子抑制剂在首次处方后 12 个月和 30 个月的保留率最高。相当大比例（47%）的患者存在中度疾病活动度。
生物 DMARD 的使用率与其他研究相似，甲氨蝶呤的使用率也符合当前 RA 管理的推荐。在中度疾病活动的 RA 患者中，需要进一步调查以了解改善疾病控制的需求。
