CONTINUITY OF 2ND-LINE DRUG-THERAPY IN RH EUMATOLOGICAL OUTPATIENT CARE

Objective: Even though it is widely agreed among rheumatologists that all patients with definite rheumatoid arthritis should receive continu ous therapy with slow acting antirheumatic drugs, according to many st udies the long-term results are disappointing. The hypothesis of the c urrent study is that treatment terminations are not sufficiently expla ined by obvious reasons like ineffectiveness and side-effects but that factors like the therapeutic setting and the psychosocial situation o f the patients have to be considered as well. In this article we repor t the continuity of the second-line drug therapy during the first 18 m onths. Methods: In a multicenter longitudinal study an inception cohor t of 300 patients with early rheumatoid arthritis (less than two years disease duration) and first prescription of a second-line antirheumat ic drug are followed-up for three years. Clinical data and patient que stionnaires are completed nine times during the observation period. Al most all rheumatologists in outpatient clinics and in private practice s in Berlin/Germany participate in the study (11 institutions). Result s: After an observation period of 18 months we find more continuous tr eatment 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 treat ed with sulphasalazine were still on the same drug. We believe that co ntinuous rheumatological outpatient care is responsible for these rath er favourable results. Prospects: As this is the first data analysis a nd the observation period of the whole study will last another three y ears no results are still available concerning the influence of the ps ychosocial situation of the patients and their health-related beliefs. These questions will be analyzed in detail when more longitudinal dat a will be available.