The national database of the German Collaborative Arthritis Centres: II. Treatment of patients with rheumatoid arthritis

Objective-To describe current treatment of patients with rheumatoid arthrit is (RA) in German rheumatology. Methods-Data from the German rheumatological database of 1998, comprising c linical and patient questionnaire data of 12 992 outpatients with RA seen a t 24 collaborative arthritis centres in Germany, were analysed. Results-At the time of documentation, 88% of the patients with RA were unde rgoing disease modifying antirheumatic drug (DMARD) treatment. Methotrexate (MTX) was prescribed to 56% of the patients (61% with seropositive and 45% with seronegative RA). Combination treatment was used in 15%. MTX was the drug of first choice even in patients with up to one year's disease duratio n (49%), followed by antimalarial drugs (21%). Patients treated by non-rheu matologists within the previous year had received DMARD treatment in only 3 3% of the cases. In steroid treatment, low doses (less than or equal to7.5 mg/day) were used by rheumatologists much more often (44%) than higher dose s (12%). 16% of the patients had been inpatients during the previous year, with a median length of stay accumulated over the year of 21 days. Together with stays in inpatient rehabilitation, 22% of all patients had had some f orm of inpatient treatment. Comprehensive measures such as occupational the rapy and patient education were prescribed to fewer than 12% of the patient s, mostly during their hospital stay. Conclusion-German rheumatologists do follow recent recommendations about ea rly and effective treatment. However, there are still deficits in outpatien t care with non-medicinal measures like occupational therapy and patient ed ucation, which may partly explain the high hospital admission rates.