Abstract
Objective: Even though it is widely agreed among rheumatologists that all patients with definite
rheumatoid arthritis should receive continuous therapy with slow acting antirheumatic
drugs, according to many studies the long-term results are disappointing. The hypothesis
of the current study is that treatment terminations are not sufficiently explained
by obvious reasons like ineffectiveness and side-effects but that factors like the
therapeutic setting and the psychosocial situation of the patients have to be considered
as well. In this article we report the continuity of the second-line drug therapy
during the first 18 months.
Methods: In a multicenter longitudinal study an inception cohort of 300 patients with early
rheumatoid arthritis (less than two years disease duration) and first prescription
of a second-line antirheumatic drug are followed-up for three years. Clinical data
and patient questionnaires are completed nine times during the observation period.
Almost all rheumatologists in outpatient clinics and in private practices in Berlin/
Germany participate in the study (11 institutions).
Results: After an observation period of 18 months we find more continuous treatment in our
cohort than it is reported from many clinical studies. Seventy seven percent of all
patients were on the first drug after 12 months, 67% after 18 months. The most frequently
prescribed drugs were methotrexate (42%) and sulphasalazine (36%). After 12 months
88% of the patients treated with methotrexate and 67 % of the patients treated with
sulphasalazine were still on the same drug. We believe that continuous rheumatological
outpatient care is responsible for these rather favourable results.
Prospects: As this is the first data analysis and the observation period of the whole study
will last another three years no results are still available concerning the influence
of the psychosocial situation of the patients and their health-related beliefs. These
questions will be analyzed in detail when more longitudinal data will be available.
Zusammenfassung
In einer multizentrischen Studie werden 300 Patienten mit nicht länger als zwei Jahre
bestehender rheumatoider Arthritis und Erstverordnung einer Basistherapie über drei
Jahre beobachtet. An der Untersuchung sind vier internistisch-rheumatologische Kliniksprechstunden
und sieben niedergelassene internistische Rheumatologen in Berlin beteiligt. Zu neun
Meßzeitpunkten wird der klinische Status erhoben, und die Patienten beantworten Fragebogen
zu Beschwerden und körperlichen Einschränkungen, Krankheits- und Therapieerleben,
Krankheitsbewältigung, sozialer Situation und Soziodemographie.
Es werden erste Ergebnisse für 262 Patienten berichtet. Am Ende des ersten Jahres
befanden sich noch 77 % der Patienten unter der erstverordneten Therapie, nach 18
Monaten noch 67%. Die beiden am häufigsten verordneten Substanzen waren Methotrexat
mit 42 % und Sulphasalazin mit 36 %. Mit Methotrexat behandelte Patienten wiesen eine
deutlich höhere Therapiekontinuität auf: So konnten von ihnen nach einem Jahr noch
88 % mit dieser Substanz behandelt werden gegenüber 67 % bei Sulphasalazin.
