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Most Rheumatologists Are Conservative in Active Rheumatoid Arthritis Despite Methotrexate Therapy: Results of the PRISME Survey
ALAIN SARAUX, VALÉRIE DEVAUCHELLE-PENSEC, LUC ENGERRAN, and RENÉ MARC FLIPO ABSTRACT. Objective. To evaluate the proportion of patients with rheumatoid arthritis (RA) visiting office-based rheumatologists for persistently active RA despite past or current methotrexate (MTX) treatment, and to describe the management of these patients in France in 2003. Methods. All French rheumatologists were invited to participate in a cross-sectional postal survey. During a predetermined week, they were to include the first 2 patients seen for RA with a history of past or current MTX treatment. Adequacy of current treatment was assessed based on the 28-joint Disease Activity Score 28 (DAS28) and on current MTX and corticosteroid regimens. Results. Of the 1800 French rheumatologists, 492 returned 838 assessable patient questionnaires. Mean patient age was 58 years and mean time since RA diagnosis was 10 years; 77% of patients were currently taking MTX, and 51% a corticosteroid. High dosages were noted for MTX (> 15 mg/week) in 20% of patients and for corticosteroid therapy (> 10 mg/day) in 5%. Nevertheless, 41% of patients had active RA (DAS28 score 3.2 to 5.1) and 7% had very active RA (DAS28 score > 5.1). The treatment was left unchanged in 78% of patients, and biological therapy was contemplated in only 16% of patients. Conclusion. Although half of MTX-treated patients with RA visiting office-based rheumatologists had active or very active disease, a change in treatment was rarely considered. (First Release June 15 2006; J Rheumatol 2006:33:1258–65) Key Indexing Terms:
RHEUMATOID ARTHRITIS
From the Department of Rheumatology, La Cavale Blanche Teaching Hospital, Brest; Wyeth France, Puteaux; and Department of Rheumatology, Roger Salengro Teaching Hospital, Lille, France. A. Saraux, MD, PhD; V. Devauchelle-Pensec, MD, Department of Rheumatology, La Cavale Blanche Teaching Hospital; L. Engerran, MD, Wyeth France; R-M. Flipo, MD, Department of Rheumatology, Roger Salengro Teaching Hospital. Address reprint requests to Prof. A. Saraux, Department of Rheumatology, La Cavale Blanche Teaching Hospital, Brest Teaching Hospitals, BP 814, F29609 Brest CEDEX, France. E-mail: Alain.Saraux@univ-brest.fr Accepted for publication February 8, 2006.
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