Blanco Francisco Javier, Ballina Javier, Carbonell Jordi, Martín-Mola Emilio, Tornero Jesús, Ramírez Esteban, Galván Jordi
Servicio de Reumatología, Hospital Universitario A Coruña, A Coruña, Galicia, España.
Reumatol Clin. 2011 Mar-Apr;7(2):88-93. doi: 10.1016/j.reuma.2010.03.007. Epub 2010 Jul 24.
Rheumatoid arthritis is clinically very heterogeneous and variable in its progression, and no one treatment works the same for all patients, as this will depend on the clinical course and specific situations.
To describe the treatment with DMARDs established for the first time in patients with rheumatoid arthritis (RA) or persistent arthritis (PA) in routine clinical practice in Spain.
Epidemiological, cross-sectional, uncontrolled, multicenter study in 15 regions of Spain during a period of five months (July to November 2006). We included patients of both genders, aged 18 years and diagnosed with RA according to ACR criteria or PA defined as any arthritis (oligoarthritis or polyarthritis) lasting ≥12 weeks, which would be given DMARD to treat their disease.
1079 patients were recruited, 915 analyzed (33% ♂/♀ 67%) meeting all the criteria required to be evaluated in the study. Mean age of patients was 54.6 (SD=15.4) years. The mean time from onset of symptoms until the 1st visit with the rheumatologist was 6.3 (11.3) months and the time from the 1st visit with the rheumatologist and the start of treatment was 4 (13.5) months. Of the patients tested, 96.7% was treated with at least one DMARD, 62.1% were given NSAIDs, corticosteroids to 59.2% and 3.8% biological therapy. In patients who received DMARDs, 90.3% received treatment with a single DMARD, 9.5% with 2 DMARDs and 0.2% with three DMARDs. In polytherapy, the DMARDs that are most often administered together were MTX + hydroxychloroquine (4.8%), MTX + leflunomide (2.0%) and MTX + sulfasalazine (1.5%). The most frequently used DMARD in monotherapy was MTX (81.3%), followed by leflunomide (4.1%) and hydroxychloroquine (3.2%). In 89.6%, the treatment of first choice was adequate according to the SER.
The most common pattern of initial treatment of RA is MTX monotherapy. Treatment of RA by rheumatologists has been homogenized in recent years.
类风湿性关节炎在临床上具有高度异质性，其病情进展也各不相同，没有一种治疗方法对所有患者都能产生相同的效果，因为这取决于临床病程和具体情况。
描述在西班牙常规临床实践中首次为类风湿性关节炎（RA）或持续性关节炎（PA）患者确立的改善病情抗风湿药（DMARDs）治疗情况。
在西班牙15个地区进行了为期五个月（2006年7月至11月）的流行病学、横断面、非对照、多中心研究。我们纳入了年龄在18岁及以上的男女患者，他们根据美国风湿病学会（ACR）标准被诊断为RA，或被定义为持续时间≥12周的任何关节炎（少关节炎或多关节炎）即PA，这些患者将接受DMARDs治疗其疾病。
共招募了1079名患者，对915名患者（男性占33%/女性占67%）进行了分析，他们符合研究评估所需的所有标准。患者的平均年龄为54.6（标准差=15.4）岁。从症状出现到首次就诊于风湿病学家的平均时间为6.3（11.3）个月，从首次就诊于风湿病学家到开始治疗的时间为4（13.5）个月。在接受检测的患者中，96.7%接受了至少一种DMARDs治疗，62.1%使用了非甾体抗炎药（NSAIDs），59.2%使用了皮质类固醇，3.8%接受了生物治疗。在接受DMARDs治疗的患者中，90.3%接受单一DMARDs治疗，9.5%接受两种DMARDs治疗，0.2%接受三种DMARDs治疗。在联合治疗中，最常一起使用的DMARDs是甲氨蝶呤（MTX）+羟氯喹（4.8%）、MTX+来氟米特（2.0%）和MTX+柳氮磺胺吡啶（1.5%）。单一治疗中最常用的DMARD是MTX（81.3%），其次是来氟米特（4.1%）和羟氯喹（3.2%）。根据西班牙风湿病学会（SER），89.6%的首选治疗是合适的。
RA初始治疗最常见的模式是MTX单一疗法。近年来，风湿病学家对RA的治疗已趋于同质化。
