G. Spencergreen et E. Spencergreen, NONSTEROIDAL THERAPY OF RHEUMATOID-ARTHRITIS AND OSTEOARTHRITIS - HOWPHYSICIANS MANAGE TREATMENT FAILURES, Journal of rheumatology, 25(11), 1998, pp. 2088-2093
Objective. Few studies have examined the practice patterns of primary
care physicians who treat patients with rheumatoid (RA) or osteoarthri
tis (OA), and the strategies used when nonsteroidal antiinflammatory d
rugs (NSAID) are ineffective or cause side effects. Our purpose was to
study practice patterns of physicians who initiate treatment of RA an
d OA, and their management approaches when NSAID are ineffective or ca
use dyspepsia. Methods. Using a structured questionnaire simulating ma
nagement of patients with RA or OA we surveyed treatment preferences o
f primary care physicians. Results. Responses from 176 physicians were
analyzed. For RA 98% used NSAID as initial therapy. For those patient
s who did not respond, most (over 60%) would either change or increase
the initial NSAID and try a mean of 2.2 different NSAID over a period
of 3.3 months before initiating second-line therapy or referring to a
rheumatologist. For OA 67% of physicians surveyed initially used NSAI
D to treat these patients, and changing or increasing the NSAID was th
e most common strategy used to manage patients not responding to initi
al therapy. For patients who developed dyspepsia taking NSAID there wa
s wide divergence of management approaches in both diseases: stopping
the NSAID and starting an analgesic (OA) or second-line agent (RA) wer
e common choices, but continuing the NSAID and adding an ''antidyspept
ic'' regimen was chosen by over half of physicians selecting a single
regimen. Most initial management approaches did not differ significant
ly between RA and OA. Conclusion. NSAID are used frequently as initial
therapy in patients with OA, and in RA the initiation of second-line
therapy is often deferred for months and is only prescribed after pati
ents have failed several NSAID. Opportunities exist to better standard
ize the approaches physicians use in the initial, management of RA and
OA, and to delineate what role NSAID should have in the management pr
ogram of these disorders.