Diagnosis and treatment of rheumatoid arthritis in the Emilia Romagna region: A prospective population-based study

Olga Addimanda, Massimiliano Marino, Ilaria Farina, Marica Trevisani, Eugenio Arrigoni, Federica Lumetti, Filippo Crescentini, Paola Sambo, Alessandra Bezzi, Marco Bruschi, Daniele Santilli, Massimo Reta, Simona Bosi, Giovanni Delsante, Francesco Girelli, Luca Montaguti, Riccardo Meliconi, Marco Sebastiani, Clodoveo Ferri, Nazzareno MalavoltaMarcello Govoni, Susanna Trombetti, Rossana de Palma, Carlo Salvarani

Research output: Contribution to journalArticlepeer-review

Abstract

Objective To perform a population-based study in rheumatoid arthritis (RA) patients, in order to evaluate the efficacy and safety of pharmacologic treatments. Methods 1087 patients with RA were enrolled; inclusion criteria were: newly diagnosed RA, already diagnosed RA with high disease activity (HDA) (DAS28≥4.2) starting biologic DMARDs (bDMARDs), already diagnosed RA with HDA continuing with conventional DMARDs (cDMARDs). The following data were collected: demographics, clinical and laboratory features, imaging and prescribed drugs. All parameters except immunology and imaging (performed yearly) were repeated at each follow-up evaluations (after 3, 6 and 12 months, and thereafter every 12 months). In order to evaluate clinical response, the EULAR response criteria were used as the gold standard. Results 414 (38.1%) newly diagnosed patients with RA, 477 (43.9%) RA patients who started bDMARDs and 196 (18.0%) RA patients who continued with cDMARDs were enrolled from April 2012 to March 2015 at 12 Rheumatology Centres in the Emilia Romagna Region. Statistical analyses showed a relative risk ratio (RRR) for moderate response of 1.65 in RA patients who started bDMARDs (p=0.16) and 2.49 for newly diagnosed RA (p=0.01). Sex, age and Health Assessment Questionnaire were not statistically significant. A RRR of 2.00 has been confirmed for RA patients who started bDMARDs (p < 0.0005) for a good response as well as 2.20 for newly diagnosed RA (p < 0.0005). An increase in adverse events among bDMARDs was found, but when looking at infections or neoplasia, no differences were highlighted between RA which started bDMARDs and RA who continued with cDMARDs. Conclusion Our results are in line with already published papers from British and Swedish Registries: a greater likelihood to have a good response is demonstrated for not longstanding RA starting cDMARDs or RA with HDA when a bDMARD is started. Also a good safety profile is demonstrated.

Original languageEnglish
Pages (from-to)201-208
Number of pages8
JournalClinical and Experimental Rheumatology
Volume35
Issue number2
Publication statusPublished - 2017

Keywords

  • Biologic DMARDS
  • Conventional DMARDS
  • Efficacy
  • Rheumatoid arthritis
  • Safety

ASJC Scopus subject areas

  • Immunology and Allergy
  • Rheumatology
  • Immunology

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