Brigham and Women's Hospital, Boston, Massachusetts.
Arthritis Care Res (Hoboken). 2013 Sep;65(9):1529-33. doi: 10.1002/acr.21997.
Use of nonbiologic disease-modifying antirheumatic drugs (DMARDs) and/or biologic DMARDs is generally recommended to improve the prognosis of patients with rheumatoid arthritis (RA). The objective of this study was to describe the changing trends in DMARD use for RA over the past 2 decades.
We analyzed data from an open longitudinal cohort of RA patients recruited from rheumatologists' practices in northern California. We examined baseline demographic and clinical characteristics of the participants and their long-term DMARD use through annual comprehensive structured telephone interviews.
A total of 1,507 established RA patients were recruited through 5 enrollment periods between 1983 and 2009. Between 1983 and 2009, the use of any DMARD increased from 71% of all patients to 83% (P for trend < 0.0001). In 2009, 43% received a biologic DMARD, 34% were on both nonbiologic and biologic DMARDs, and 40% were treated with only nonbiologic DMARDs. The 4 most commonly used nonbiologic DMARDs in 2009 were methotrexate (49%), hydroxychloroquine (30%), leflunomide (13%), and sulfasalazine (7%). Etanercept (20%) was the most commonly used biologic DMARD in 2009, followed by infliximab (10%), adalimumab (9%), and abatacept (6%). Use of oral steroids was common (40-50%) and remained similar throughout the study period.
There has been a significant increase in the use of DMARDs for RA over the past 2 decades. However, 15% of the individuals with a clinical diagnosis of RA were not receiving DMARDs in 2009. Future research should focus on sociodemographic and clinical factors associated with DMARD use for RA.
使用非生物性疾病修饰抗风湿药物（DMARDs）和/或生物性 DMARDs 通常被推荐用于改善类风湿关节炎（RA）患者的预后。本研究的目的是描述过去 20 年来 RA 患者 DMARD 使用的变化趋势。
我们分析了来自加利福尼亚北部风湿病医生诊所的 RA 患者的开放纵向队列研究数据。我们通过每年一次的全面结构化电话访谈，检查了参与者的基线人口统计学和临床特征及其长期 DMARD 使用情况。
共招募了 1507 名确诊的 RA 患者，这些患者是在 1983 年至 2009 年的 5 个招募期间入组的。在 1983 年至 2009 年期间，所有患者中使用任何 DMARD 的比例从 71%增加到 83%（趋势 P<0.0001）。在 2009 年，43%的患者接受了生物性 DMARD，34%的患者同时接受了非生物性和生物性 DMARD，40%的患者仅接受了非生物性 DMARD。2009 年最常用的 4 种非生物性 DMARD 分别是甲氨蝶呤（49%）、羟氯喹（30%）、来氟米特（13%）和柳氮磺胺吡啶（7%）。2009 年最常用的生物性 DMARD 是依那西普（20%），其次是英夫利昔单抗（10%）、阿达木单抗（9%）和阿巴西普（6%）。口服类固醇的使用很常见（40%-50%），且在整个研究期间保持相似。
在过去的 20 年中，RA 的 DMARD 使用显著增加。然而，2009 年仍有 15%的临床诊断为 RA 的患者未接受 DMARD 治疗。未来的研究应重点关注与 RA 患者 DMARD 使用相关的社会人口统计学和临床因素。
