Treatment profiles in different groups of RA-sufferers: description, analysis, evaluation.

(1) 50 to 80% of all rA-sufferers treated by rheumatologists have received second line therapy in contrast to 7 to 27% at the community level. (2) Disease duration and disease activity do not seem to affect the treatment regimens of primary and other physicians working in or around Hannover. The same holds true for social and demographic characteristics of the patients. (3) RA-sufferers are generally undertreated by community based doctors with regard to RiD-therapy and disease activity. Approximately 80% of patients with formal indication for the use of RiDs have not received these drugs, despite the fact that a rheumatological department with an outpatient clinic providing more than 3500 consultations per year has existed for more than 20 years at the Medizinische Hochschule Hannover. This outpatient clinic is utilized by more than 60% of all general practitioners as well as internal and orthopedic physicians working in the city of Hannover. We thus have to admit a rather low community effectiveness of our service. (4) A sensitivity of the formal evaluation-scheme of 0.70 and a specificity of 0.80 imply 30% false-negative and 20% false-positive assessments. In view of the larger number of false-negative judgements one must assume an even greater difference between treatment-reality and rheumatological concepts. (5) Sofar we cannot offer any safe explanation for the reasons underlying this unsatisfactory situation. The predictors we have investigated up to now have not proven to be selective. (6) Nevertheless, practical steps are urgently required, in order to be rheumatologically more effective at the community level--at least in Hannover/FRG.