Background: Early Arthritis Clinics (EAC) have been developed to allow an early identification of Early Rheumatoid Arthritis (ERA) and to offer the best therapeutic approach to each patient. Objectives: To assess the impact of the EAC as a QI of a clinical practice program of recruitment of early arthritis patients referred to three different italian centres placed in a small province, intermediate province and a metropolitan area, respectively. Methods: From February 2007 to July 2009, 1795 early arthritis patients (symptoms duration less than 12 months) attending three different Academic Centres (Jesi, Pavia and Rome), were enrolled in the study. The research project was supported by the Italian Ministry of Health. Clinical, immunological and radiographic data of each patient have been recorded. In patients fulfilling an ERA diagnosis various therapeutic algorithms (related to different corticosteroid dosage and the time of use of DMARDs and/or anti-TNF drugs), according to each centre, were adopted. The main shared outcome was to achieve remission after 12 months of follow-up. Referral was recorded in order to assess which was the best approach to reach the target. DAS, HAQ, RF and ACPA levels were recorded, as well, to define possible predictors of EULAR remission (DAS<2.6). The statistical study was performed through univariate and logistic regression analysis. Results: Out of 1795 patients, 711 (39.6%) were diagnosed as having ERA. The percentage of patients referred by general practitioners (GPs) ranged from 60 to 65%. Women were 74%, the mean age was 54.7±12.4 years and the mean disease duration was 6.4±4.4 months. 20.8% of patients had very ERA (VERA) (disease duration<3 months). 38.3% of patients were ACPA positive and 42.6% RF positive. 530 ERA patients underwent a radiographic assessment and 32.6% had at least one documented erosion. A follow-up of 12 months was available for 481 patients. In these patients baseline DAS28 value was 5.4±1.1, HAQ 1.15±0.6, CRP 23±26 mg/L. After 12 months DAS<2.6 was seen in 34.3% of the whole cohort (lowest 19.5, highest 49%). According to ACR criteria only 15.6% of the patients reached remission. Residual minimal disease activity (RMDA) was reached in 42.6% (lowest 17.1, highest 65%), and an HAQ<0.5 was seen in 60.9% (lowest 41.9, highest 78%). The lowest % of VERA patients recruited by the three centres was 1%, whilst the highest was 49.6%. VERA (OR 2.03, IC95% 1.25-3.30) and concomitant DMARDs treatment (OR 1.65, IC95% 1.06-2.55) revealed to be the strongest predictors of DAS28 remission after 12 months of follow-up. Conclusions: Considering referral, time to recruitment, symptoms duration before referral, clinical prognostic factors at baseline and remission, our results suggest a great discrepancy among 3 rheumatologic centres involved in the study. Moreover, the data suggest that VERA represents a critical window of opportunity for RA to obtain remission in a real world setting. The EAC are crucial to this aim.
Access of arthritis patients to an early arthritis clinic in three different settings: the very early ra represents the best clinical and therapeutic opportunity to reach das remission. Quality indicators (QI) of the italian ministry of health program
Gremese E;
2011-01-01
Abstract
Background: Early Arthritis Clinics (EAC) have been developed to allow an early identification of Early Rheumatoid Arthritis (ERA) and to offer the best therapeutic approach to each patient. Objectives: To assess the impact of the EAC as a QI of a clinical practice program of recruitment of early arthritis patients referred to three different italian centres placed in a small province, intermediate province and a metropolitan area, respectively. Methods: From February 2007 to July 2009, 1795 early arthritis patients (symptoms duration less than 12 months) attending three different Academic Centres (Jesi, Pavia and Rome), were enrolled in the study. The research project was supported by the Italian Ministry of Health. Clinical, immunological and radiographic data of each patient have been recorded. In patients fulfilling an ERA diagnosis various therapeutic algorithms (related to different corticosteroid dosage and the time of use of DMARDs and/or anti-TNF drugs), according to each centre, were adopted. The main shared outcome was to achieve remission after 12 months of follow-up. Referral was recorded in order to assess which was the best approach to reach the target. DAS, HAQ, RF and ACPA levels were recorded, as well, to define possible predictors of EULAR remission (DAS<2.6). The statistical study was performed through univariate and logistic regression analysis. Results: Out of 1795 patients, 711 (39.6%) were diagnosed as having ERA. The percentage of patients referred by general practitioners (GPs) ranged from 60 to 65%. Women were 74%, the mean age was 54.7±12.4 years and the mean disease duration was 6.4±4.4 months. 20.8% of patients had very ERA (VERA) (disease duration<3 months). 38.3% of patients were ACPA positive and 42.6% RF positive. 530 ERA patients underwent a radiographic assessment and 32.6% had at least one documented erosion. A follow-up of 12 months was available for 481 patients. In these patients baseline DAS28 value was 5.4±1.1, HAQ 1.15±0.6, CRP 23±26 mg/L. After 12 months DAS<2.6 was seen in 34.3% of the whole cohort (lowest 19.5, highest 49%). According to ACR criteria only 15.6% of the patients reached remission. Residual minimal disease activity (RMDA) was reached in 42.6% (lowest 17.1, highest 65%), and an HAQ<0.5 was seen in 60.9% (lowest 41.9, highest 78%). The lowest % of VERA patients recruited by the three centres was 1%, whilst the highest was 49.6%. VERA (OR 2.03, IC95% 1.25-3.30) and concomitant DMARDs treatment (OR 1.65, IC95% 1.06-2.55) revealed to be the strongest predictors of DAS28 remission after 12 months of follow-up. Conclusions: Considering referral, time to recruitment, symptoms duration before referral, clinical prognostic factors at baseline and remission, our results suggest a great discrepancy among 3 rheumatologic centres involved in the study. Moreover, the data suggest that VERA represents a critical window of opportunity for RA to obtain remission in a real world setting. The EAC are crucial to this aim.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
