DEMOGRAPHIC, CLINICAL CHARACTERISTICS AND DRUG PRESCRIPTION PATTERN IN PATIENTS WITH RHEUMATOID ARTHRITIS IN SOUTH INDIAN TERTIARY CARE HOSPITAL
Keywords:
Rheumatoid Arthritis, Treatment pattern, DMARDs, Demography, DAS28 ESR, DAS28 CRPAbstract
Objective: The objective of the study was to describe demographic, clinical features and drug treatment pattern among rheumatoid arthritis (RA) patients in a south Indian tertiary care hospital.
Methods: In this retrospective study, a total of 789 patients diagnosed with RA were enrolled from October 2013 to December 2015 in tertiary care hospital irrespective of age and gender. Data of the patients were obtained from Medical Record Department (MRD), and all the data were documented in a suitable designed Case Record Form (CRF). The data were analyzed using SPSS 20.0 and Excel 2013.
Results: There were 628 females and 161 males with mean age 47.6±12.6 and 47.1±14.4 y respectively. The ratio of male to female was 1:3.9. Most of the RA patients were housewives (66.4%). The mean disease duration was 4.3±4.5 y. The majority of patients (59.3%) had disease duration of more than 24 mo. Hypertension (21.5%) was the most common comorbid condition in our study population. Iron deficiency anemia (IDA) was observed in 10.6% of RA patients. Serum C-reactive protein (CRP) was positive in 89.3%. The majority of patients (87.7%) received DMARDs. As the disease, duration increased the severity of disease also increased. Majority of patients were prescribed with dual DMARDs in combination (52.3%).
Conclusion: We observed female was dominant over the male in number and majority of patients had a later stage of the disease probably due to lack of medical facility or financial problems in the lower income groups. We observed that methotrexate plus hydroxychloroquine combination was commonly used in both high and moderate disease activity groups which may be due to a better outcome and minimal adverse effects.
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References
Harris ED. Clinical features of rheumatoid arthritis. Kelley's Textbook of Rheumatology. 7th ed. Philadelphia, Pa: Saunders Elsevier; 2005.
Gibofsky A. Overview of epidemiology, pathophysiology, and diagnosis of rheumatoid arthritis. Am J Managed Care 2012;18 Suppl 13:295-302.
Mijiyawa M. Epidemiology and semiology of rheumatoid arthritis in third world countries. Rev Rhum 1995;62:121-6.
Malaviya AN, Kapoor SK, Singh RR, Kumar A, Pande I. Prevalence of rheumatoid arthritis in the adult Indian population. Rheumatol Int 1993;13:131-4.
Firestein GS, Budd R, Gabriel SE, O'Dell JR, McInnes IB. Kelley's textbook of rheumatology. Elsevier Health Sciences; 2012.
Mota LM, Cruz BA, Brenol CV, Pereira IA, Fronza LS, Bertolo MB, et al. Consensus of the Brazilian society of rheumatology for diagnosis and early assessment of rheumatoid arthritis. Rev Bras Reumatol 2011;51:207-19.
Liao KP, Alfredsson L, Karlson EW. Environmental influences on risk for rheumatoid arthritis. Curr Opin Rheumatol 2009;21:279.
Tuomi T, Heliövaara M, Palosuo T, Aho K. Smoking, lung function, and rheumatoid factors. Ann Rheum Dis 1990;49:753-6.
Abdel-Nasser AM, Rasker JJ, Vaikenburg HA. Epidemiological and clinical aspects relating to the variability of rheumatoid arthritis. Semin Arthritis Rheum 1997;27:123-40.
Alballa SR. The expression of rheumatoid arthritis in Saudi Arabia. Clin Rheumatol 1995;14:641-5.
Michaud K, Wolfe F. Comorbidities in rheumatoid arthritis. Best Pract Res Clin Rheumatol 2007;21:885-906.
Wolfe F, Mitchell DM, Sibley JT, Fries JF, Bloch DA, Williams CA, et al. The mortality of rheumatoid arthritis. Arthritis Rheum 1994;37:481-94.
Gabriel SE, Michaud K. Epidemiological studies in incidence, prevalence, mortality, and comorbidity of the rheumatic diseases. Arthritis Res Ther 2009;11:229.
Gabriel SE. Why do people with rheumatoid arthritis still die prematurely? Ann Rheum Dis 2008;67 Suppl 3:iii30-4.
Al-Bishri J, Attar SM, Bassuni N, Al-Nofaiey Y, Qutbuddeen H, Al-Harthi S, et al. Comorbidity profile among patients with rheumatoid arthritis and the impact on prescriptions trend. Clin Med: Arthritis Musculoskeletal Disord 2013;6:11.
Wotton CJ, Goldacre MJ. Risk of invasive pneumococcal disease in people admitted to hospital with selected immune-mediated diseases: record linkage cohort analyses. J Epidemiol Community Health 2012;66:1177-81.
Liao KP, Solomon DH. Traditional cardiovascular risk factors, inflammation and cardiovascular risk in rheumatoid arthritis. Rheumatology 2013;52:45-52.
Desai SS, Myles JD, Kaplan MJ. Suboptimal cardiovascular risk factor identification and management in patients with rheumatoid arthritis: a cohort analysis. Arthritis Res Ther 2012;14:270.
Solomon DH, Karlson EW, Curhan GC. Cardiovascular care and cancer screening in female nurses with and without rheumatoid arthritis. Arthritis Care Res 2004;51:429-32.
Sowden E, Mitchell WS. An audit of influenza and pneumococcal vaccination in rheumatology outpatients. BMC Musculoskeletal Disord 2007;8:1.
Kim SC, Schneeweiss S, Myers JA, Liu J, Solomon DH. No differences in cancer screening rates in patients with rheumatoid arthritis compared to the general population. Arthritis Rheum 2012;64:3076-82.
Van der Heijde DM, Van't Hof MA, Van Riel PL, Theunisse LA, Lubberts EW, van Leeuwen MA, et al. Judging disease activity in clinical practice in rheumatoid arthritis: first step in the development of a disease activity score. Ann Rheum Dis 1990;49:916-20.
Prevoo ML, Van't Hof MA, Kuper HH, Van Leeuwen MA, Van De Putte LB, Van Riel PL. Modified disease activity scores that include twentyâ€eightâ€joint counts development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum 1995;38:44-8.
Smolen JS, Han C, Bala M, Maini RN, Kalden JR, Van der Heijde D, et al. Evidence of radiographic benefit of treatment with infliximab plus methotrexate in rheumatoid arthritis patients who had no clinical improvement: a detailed subanalysis of data from the anti–tumor necrosis factor trial in rheumatoid arthritis with concomitant therapy study. Arthritis Rheum 2005;52:1020-30.
Vander Cruyssen B, Van Looy S, Wyns B, Westhovens R, Durez P, Van den Bosch F, et al. DAS28 best reflects the physician's clinical judgment of response to infliximab therapy in rheumatoid arthritis patients: validation of the DAS28 score in patients under infliximab treatment. Arthritis Res Ther 2005;7:1063.
Weinblatt ME, Keystone EC, Furst DE, Kavanaugh AF, Chartash EK, Segurado OG. Long-term efficacy and safety of adalimumab plus methotrexate in patients with rheumatoid arthritis: ARMADA 4 y extended study. Ann Rheum Dis 2006;65:753-9.
Maillefert JF, Combe B, Goupille P, Cantagrel A, Dougados M. Long term structural effects of combination therapy in patients with early rheumatoid arthritis: five years follow-up of a prospective double-blind controlled study. Ann Rheum Dis 2003;62:764-6.
Wells G, Becker JC, Teng J, Dougados M, Schiff M, Smolen J, et al. Validation of the 28-joint disease activity score (DAS28) and european league against rheumatism response criteria based on C-reactive protein against disease progression in patients with rheumatoid arthritis, and comparison with the DAS28 based on erythrocyte sedimentation rate. Ann Rheum Dis 2009;68:954-60.
Anderson J, Caplan L, Yazdany J, Robbins ML, Neogi T, Michaud K, et al. Rheumatoid arthritis disease activity measures: american college of rheumatology recommendations for use in clinical practice. Arthritis Care Res 2012;64:640-7.
Saag KG, Teng GG, Patkar NM, Anuntiyo J, Finney C, Curtis JR, et al. American college of rheumatology 2008 recommendations for the use of nonbiologic and biologic diseaseâ€modifying antirheumatic drugs in rheumatoid arthritis. Arthritis Care Res 2008;59:762-84.
Singh JA, Furst DE, Bharat A, Curtis JR, Kavanaugh AF, Kremer JM, et al. Update of the 2008 American college of rheumatology recommendations for the use of diseaseâ€modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis. Arthritis Care Res 2012;64:625-39.
Tugwell P, Shea B, Boers M, Brooks P, Simon L, Strand V. editors. Evidence-based rheumatology. John Wiley and Sons; 2009.
Gabriel SE, Coyle D, Moreland LW. A clinical and economic review of disease-modifying antirheumatic drugs. Pharmacoeconomics 2001;19:715-28.
Bajraktari IH, Teuta BÇ, Vjollca SM, Bajraktari H, Saiti V, Krasniqi B, et al. Demographic features of patients with rheumatoid arthritis in kosovo. Med Arch 2014;68:407.
Aletaha D, Smolen JS. The rheumatoid arthritis patient in the clinic: comparing more than 1300 consecutive DMARD courses. Rheumatology 2002;41:1367-74.
Owino BO, Oyoo GO, Otieno CF. Socio-demographic and clinical aspects of rheumatoid arthritis. East Afr Med J 2009;86:204-11.
Fairweather D, Frisancho-kiss S, Rose NR. Sex differences in autoimmune disease from a pathological perspective. Am J Pathol 2008;173:600-9.
Gremese E, Carletto A, Padovan M, Atzeni F, Raffeiner B, Giardina AR, et al. Obesity and reduction of the response rate to anti–tumor necrosis factor α in rheumatoid arthritis: an approach to personalized medicine. Arthritis Care Res 2013;65:94-100.
Ajeganova S, Andersson ML, Hafström I. Association of obesity with worse disease severity in rheumatoid arthritis as well as with comorbidities: A longâ€term follow-up from disease onset. Arthritis Care Res 2013;65:78-87.
Bal A, Ataman Åž, Bodur H, Rezvani A, Paker N, TaÅŸtekin N, et al. Characteristics of patients with rheumatoid arthritis in turkey: results from the turkish league against rheumatism rheumatoid arthritis registry. Arch Rheumatol 2015;30:i-viii.
Heliövaara M, Aho K, Aromaa A, Knekt P, Reunanen A. Smoking and risk of rheumatoid arthritis. J Rheumatol 1993;20:1830-5.
Papadopoulos NG, Alamanos Y, Voulgari PV, Epagelis EK, Tsifetaki N, Drosos AA. Does cigarette smoking influence disease expression, activity and severity in early rheumatoid arthritis patients? Clin Exp Rheumatol 2005;23:861.
Vreugdenhil G, Wognum AW, Van Eijk HG, Swaak AJ. Anaemia in rheumatoid arthritis: the role of iron, vitamin B12, and folic acid deficiency, and erythropoietin responsiveness. Ann Rheum Dis 1990;49:93-8.
Swaak A. Anemia of chronic disease in patients with rheumatoid arthritis: aspects of prevalence, outcome, diagnosis, and the effect of treatment on disease activity. J Rheumatol 2006;33:1467.
Wolfe FR, Hawley DJ. The comparative risk and predictors of gastrointestinal adverse events in rheumatoid arthritis and osteoarthritis: a prospective 13 y study of 2131 patients. J Rheumatol 2000;27:1668-73.
Inoue E, Yamanaka H, Hara M, Tomatsu T, Kamatani N. Comparison of disease activity score (DAS) 28-erythrocyte sedimentation rate and DAS28-C-reactive protein threshold values. Ann Rheum Dis 2007;66:407-9.
Almeida M do STM, Almeida JVM, Bertolo MB. Demographic and clinical features of patients with rheumatoid arthritis in Piaui, Brazil-evaluation of 98 patients. Rev Bras Reumatol 2014;54:360–5.
Kvien TK, Heiberg MS, Lie E, Kaufmann C, Mikkelsen K, Nordvag B, et al. A norwegian DMARD register: prescriptions of DMARDs and biological agents to patients with inflammatory rheumatic diseases. Clin Exp Rheumatol 2005;23(5, Suppl 39):188-94.
Lapadula G, Ferraccioli G, Ferri C, Punzi L, Trotta F. GISEA: an Italian biological agents registry in rheumatology. Reumatismo 2011;63:155-64.
Sokka T. Increases in use of methotrexate since the 1980s. Clinical and Experimental Rheumatology 2010;28(5 Suppl 61):S13-20.