TREATMENT PERSPECTIVES IN RHEUMATOID-ARTHRITIS - A DESCRIPTIVE STUDY IN A SWEDISH HEALTH-CARE DISTRICT

This study analyses patterns of treatment offered to individuals with a clinical diagnosis of rheumatoid arthritis (RA). A cross-sectional i nvestigation was carried out in 321 patients (aged >16 years) fulfilli ng the 1958 American Rheumatism Association (ARA) criteria for RA. Med ical records were scrutinised retrospectively for information about me dical, surgical and other treatments during a 5-year period (1982 to 1 986). All patients had received medical treatment, but a large number had discontinued drug therapy because of adverse effects or lack of ef ficacy. 45.9% of the individuals were receiving 1 drug at the time of the survey, 33.8% were on 2 drugs, 11.7% were on 3 or 4 drugs, and 8.6 % were not receiving any medication, Nearly 50% of the patients had ha d various kinds of surgical procedures performed. The clinical manifes tation of the disease, as measured by the number of ARA criteria fulfi lled, showed a linear correlation to nearly all medical and surgical t reatments. A primary healthcare physician was the basic contact person for 90% of the patients, but in addition 70% of the participants had been examined at sometime by a rheumatological specialist. The study c onfirms our expectations that patients with RA receive numerous pharma ceutical and other treatments. Even patients with mild and/or early di sease (probable RA) had received a considerable amount of treatment. Q ualified specialised care was also provided despite the distance to a university referral centre. Increased compliance by patients receiving drug therapy for RA might have pharmacoeconomic benefits through a lo wer incidence of discontinuation of treatment due to lack of effect.