Ward M M, Fries J F
Medical Service, Veterans Administration Palo Alto Health Care System, CA 94304, USA.
J Rheumatol. 1998 Mar;25(3):408-16.
To describe changes in antirheumatic medication use by patients with rheumatoid arthritis (RA) over the 15 years 1981 to 1996.
Medication use was ascertained every 6 months by mailed Health Assessment Questionnaire in a cohort of patients recruited from the local community (n = 305; mean duration of RA at study entry 14.2 yrs). Patients were treated by 53 rheumatologists and over 200 other physicians during the study. The proportions of patients treated with nonsteroidal antiinflammatory drugs (NSAID), disease modifying antirheumatic drugs (DMARD), prednisone, intraarticular corticosteroids, and analgesics were determined in serial cross sectional analyses, and trends in medication use over time were analyzed using linear regression.
From 1981 to 1996, the proportion of patients treated with DMARD increased from 32 to 47% (average increase 1.06% each year; p < 0.0001), while the proportion treated with NSAID decreased from 86 to 76% (average decrease 0.57% each year; p < 0.0001). The proportion of patients treated with prednisone remained between 30 and 40%, with a trend toward increasing use over time (average increase 0.2% each year; p = 0.05). In contrast, the proportion treated with intraarticular corticosteroids decreased from 14.4 to 6.7% (average decrease 0.46% each year; p < 0.0001). In 1996, the most prevalent patterns of medication use were the use of NSAID alone (24.4%), use of an NSAID and DMARD (16.3%), and use of an NSAID, DMARD, and prednisone (12.2%). Use of an NSAID as the only antirheumatic medication decreased over time, and the use of DMARD in combination with other medications increased.
The proportion of patients with RA treated with DMARD increased substantially from 1981 to 1996. This change in practice occurred during the time in which the concept of inverting the traditional therapeutic pyramid became popular, and may reflect a translation among clinicians of the philosophy of "early DMARD use" to "consistent DMARD use," even among patients with RA of moderate or longstanding duration.
描述1981年至1996年这15年间类风湿关节炎（RA）患者抗风湿药物使用情况的变化。
通过邮寄健康评估问卷，每6个月确定一次从当地社区招募的一组患者（n = 305；研究开始时RA的平均病程为14.2年）的药物使用情况。在研究期间，患者由53名风湿病学家和200多名其他医生进行治疗。在系列横断面分析中确定使用非甾体抗炎药（NSAID）、改善病情抗风湿药（DMARD）、泼尼松、关节内注射皮质类固醇和镇痛药治疗的患者比例，并使用线性回归分析药物使用随时间的趋势。
从1981年到1996年，接受DMARD治疗的患者比例从32%增加到47%（平均每年增加1.06%；p < 0.0001），而接受NSAID治疗的患者比例从86%下降到76%（平均每年下降0.57%；p < 0.0001）。接受泼尼松治疗的患者比例保持在30%至40%之间，且随着时间推移有增加趋势（平均每年增加0.2%；p = 0.05）。相比之下，接受关节内注射皮质类固醇治疗的患者比例从14.4%下降到6.7%（平均每年下降0.46%；p < 0.0001）。1996年，最常见的用药模式是单独使用NSAID（24.4%）、使用NSAID和DMARD（16.3%）以及使用NSAID、DMARD和泼尼松（12.2%）。仅将NSAID作为抗风湿药物使用的情况随时间减少，而DMARD与其他药物联合使用的情况增加。
从1981年到1996年，接受DMARD治疗的RA患者比例大幅增加。这种实践中的变化发生在传统治疗金字塔倒置的概念开始流行的时期，可能反映了临床医生将“早期使用DMARD”的理念转变为“持续使用DMARD”的理念，即使在病程中等或较长的RA患者中也是如此。
