A Cost Variation Analysis of Drugs Prescribed for The Treatment of Rheumatoid Arthritis

Background: The rheumatologists have several drugs to choose from, either alone or in combination; each with different costs, monitoring protocols, and potential risks and benefits. Pharmacoeconomic analysis results help rheumatologists choose drugs for their patients. Objective: Objective of this prospective observational study was to perform a cost-variation analysis of drugs prescribed for the treatment of rheumatoid arthritis (RA) in a Western-Indian tertiary care teaching hospital. Materials and Methods: This prospective observational study was conducted in the rheumatology department of the study site. Study population included patients of both gender male and female, diagnosed with rheumatoid arthritis and on treatment. Prices of the drugs prescribed to the patients were obtained from different offline and online sources. The lowest and highest cost of brands in rupees (INR) for each drug, the cost ratio, percentage cost variation, and monthly cost for all the prescribed drugs were calculated. Results: In our study, out of total 142 patients, 93 were females and 49 were males and the mean age was 49.11±15.89 years. Most patients were prescribed with Disease-modifying antirheumatic drugs (DMARDs). Frequently used nonsteroidal anti-inflammatory drug (NSAID) was Diclofenac (n=48). A maximum cost ratio (15.6) was observed with prednisolone 5 mg TDS. The costliest and cheapest brand of prednisolone 5 mg TDS accounted for the maximum cost variability (1460%). Mean monthly cost varied among different drug classes. Conclusion: Average cost of illness of patient with RA was estimated to be in the range of 2406/month to 2858/month in the year 2021.

Los niveles séricos de Interleucina 22 e Interleucina 6 disminuyen luego del tratamiento en pacientes con artritis reumatoidea / Interleukin 22 and Interleukin 6 Serum Levels Decrease After Treatment in Rheumatoid Arthritis Patients

Introducción: La artritis reumatoidea se caracteriza por inflamación de la membrana sinovial debido al infiltrado de células inmunitarias que secretan citocinas relacionadas a perfil Th17 como IL-22 e IL-6. La dinámica de estas citocinas durante el tratamiento permanece incomprendida. El objetivo fue evaluar los niveles séricos y en líquido sinovial (LS) de IL-22 e IL-6, correlacionarlos con diferentes parámetros bioquímicos y clínicos y medir sus cambios post-tratamiento. Material y métodos: Se estudiaron 77 pacientes con AR y 30 controles. A 30 pacientes se los evaluó nuevamente luego de 3 meses de tratamiento y a 12 se les extrajo LS. Se midió VSG, PCR, FR, anti-CCPhs, IL-22 e IL-6. Se evaluó la actividad con DAS28 y respuesta al tratamiento con criterios EULAR. Resultados: IL-22 e IL-6 fueron similares entre pacientes y controles. Sus niveles disminuyeron luego del tratamiento, principalmente en pacientes respondedores. IL-22 fue menor e IL-6 mayor en LS que en sangre. IL-6 correlacionó positivamente con PCR y anti-CCPhs. Los niveles de VSG, PCR y DAS28 fueron mayores en pacientes con valores dosables de IL-6 que en no dosables. Conclusión: En pacientes con valores basales dosables de IL-22 e IL-6, los niveles de estas citocinas podrían utilizarse como marcador adicional de respuesta al tratamiento.

Introduction: Rheumatoid arthritis is characterized by synovium inflammation due to the infiltration of immune cells that secrete Th17 cytokines like IL-22 and IL-6. The dynamics of these cytokines during the treatment remain unknown. The aim of this study was to evaluate the levels of IL-22 and IL-6 serum and synovial fluid (SF) in correlation with different biochemical and clinical parameters and treatment-associated changes. Material and methods: Seventy-seven RA patients and 30 controls were recruited. Thirty patients were evaluated after 3 months of treatment and SF was collected of 12 patients. ESR, CRP, RF, anti-CCP hs, IL-22 e IL-6 were measured. DAS28 was used to assess disease activity and response to treatment followed EULAR criteria. Results: There were not differences in serum IL-22 and IL-6 levels between patients and controls. Cytokine levels decreased after treatment, mainly in responder patients. IL-22 was decreased and IL-6 was increased in SF compared to serum. IL-6 correlated positively with CRP and anti-CCPhs. ESR, CRP and DAS28 were increased in patients with detectable IL-6 compared to those with undetectable IL-6. Conclusion: In patients with detectable serum IL-22 and IL-6 levels before treatment initiation, follow-up of cytokine levels could be an useful additional tool to evaluate treatment response.

Neutrophil-to-lymphocyte ratio in systemic lupus erythematosus is influenced by steroids and may not completely reflect the disease activity

Objectives: Neutrophil-to-lymphocyte ratio (NLR) has emerged as an important parameter in inflammatory network andcould pave the way for newer treatment strategies in systemic lupus erythematosus (SLE). The study evaluated NLR as apredictor of disease activity in SLE and attempted to relate the factors influencing the NLR.Methods: The study included 117 SLE patients fulfilling the systemic lupus international collaborating clinics/AmericanCollege of Rheumatology (SLICC/ACR) criteria (2010). The subjects were classified into mild, moderate, and severesystemic lupus erythematosus disease activity index 2000 (SLEDAI 2K) groups and compared. NLR values were classifiedas ≤2, >2–4 and >4 groups and its relationship with study variables was evaluated by Notched box-and-Whisker plots,Spearman correlation and Mountain plot. ROC and multiple linear regression were used to verify discriminatory abilityand factors influencing NLR respectively.Results: Approximately 24% (n=28) of patients each had mild and moderate SLEDAI disease activities, and 52.14% (n=61)had severe activity. Patients with severe disease activity were significantly younger (31.69±10.09 years) and were onmore immunosuppressants/DMARDs. The patients in the >4 NLR group had significantly elevated total leucocyte count(TLC) 5560 (3360-11480) cells/mm3 and CRP 4.46 (0.3-48.2) mg/L and more patients were on steroid therapy. The >2-4NLR group had moderate inverse correlation with SLEDAI. NLR, ESR, CRP, and C3 did not show agreement with SLEDAI.The NLR was associated with CRP and steroid usage and could not discriminate disease severity.Conclusion: The relationship of the NLR with SLEDAI was not consistent. NLR was associated with CRP and steroid use.NLR as a marker of inflammation or as a predictor of SLE disease activity needs further investigation.

A Comparative Study On Pharmacoeconomic Analysis Of Rheumatoid Arthritis Patient In Two Different Hospitals In Tamil Nadu

Objective: The objective of the present study is to compare the prescribing patterns and cost of illness of Rheumatoid arthritis patients in two different hospitals. Methods: This is an observational study conducted in two different tertiary care hospitals in Salem district after obtaining approval of the Institutional Ethics Committee (IEC) (Registration Number EC/PHARM D/2019.06). A sample size of 102 (above 18 y) patients were included (52 from group 1 hospital and 50 from group 2 hospital). The study was conducted over a period of 6 mo from February 2019 to July 2019. The cost was collected by a patient face-to-face interview. Results: Out of 102 patients, females (57.84%) patients were more prevalent than men with the age group of 50-59 y in both groups. Methotrexate was most commonly prescribed drug in group 1(36.5%), whereas in group 2 are Sulfasalazine (37%). Among the DMARDs unit cost of methotrexate is high but the monthly cost was high for Sulfasalazine, because the methotrexate is prescribed on a once-weekly basis while sulfasalazine is taken twice a day. The cost of NSAIDs comes around 46.47% of the total drug cost of the month. In steroids, cost comes around 11.73% of the total drug cost. Among the direct cost of two groups, the drug cost and transportation cost is higher when compared with other costs. Indirect costs such as lost wages, due to disease is higher in group 1. Conclusion: The study concluded that the burden of RA to the patient is huge, Appropriate standard prescribing guidelines should be developed and implementation of the rational drug must be promoted. Polypharmacy was reported in group 1 hospital, the progression of symptoms was the same in both hospitals, it increases the cost of therapy and overall cost of patients. Hence it becomes vital to diagnose and control the disease at an early stage to control the economic burden on the patient.

Sociodemographic and drug prescription pattern in patients with rheumatoid arthritis in a tertiary care teaching hospital

Background: Rheumatoid arthritis (RA) is a chronic systemic autoimmune inflammatory disease that affects mainly the small joints of the hands and feet. RA is widely prevalent throughout the world.Methods: A prospective and observational study was carried out on 44 patients for 6 months. Patients of either sex, aged between 18 to 70 years diagnosed with rheumatoid arthritis were screened and recruited in the study. Patients were diagnosed on the basis of clinical assessment and the lab parameters assessed were rheumatoid factor and anti-CCP (anti-cyclic citrullinated peptide antibody). Prescriptions were analyzed for socio-demographic details and drug prescribing pattern.Results: Out of 44 patients, 36 (81.82%) were females, 8 (18.18%) were males. Maximum occurred 19 (43.18) between 31 to 40 years of age. Out of 19 (43.18%), females were 16 (36.36%), males were 3 (6.83%). 39 (88.63%) were from rural and 5 (11.37%) from urban area, 21 (47.73%) illiterate, 15 (34.09%) primary educated, 7 (15.91%) secondary educated, 1 (2.27%) educated above higher secondary, 4 (9.08%) unemployed, 2 (4.55%) students, 19 (43.18%) housewives, 7 (15.91%) agricultural workers, 7 (15.91%) non-agricultural outdoor workers and 5 (11.37%) non-agricultural indoor workers. Most common co-morbidity was hypertension 28 (63.63%). Anti-CCP was positive in 38 (86.36%). All of the patients 44 (100%) received disease-modifying anti-rheumatic drugs (DMARDs). Majority of the patients were prescribed with triple DMARDs combination 30 (68.18%).Conclusions: We observed that female were dominant over the male with male: female ratio of 1: 4.5. Prescriptions pattern was primarily based on DMARDs.

Experience in quality control of clinical trials of DMARDs / 中国临床药理学与治疗学

In recent years, many new DMARDs have been emerging, mainly in bDMARDs and tsDMARDs. With the increasing number of clinical trials, it is of great significance to strengthen the quality control of clinical trials. This paper analyzes the key points and difficulties in practice that the investigator should pay attention to in the b/tsDMARDs clinical trials, as well as the quality control concerns of the clinical trials of such drugs. Some methods are put forward to solve questions above in order to help improve the quality of such clinical trials.

Reumatología y COVID-19: una oportunidad única / Rheumatology and COVID-19: a unique opportunity

Las pandemias han sido inherentes a la presencia del ser humano en el planeta tierra. Desde el inicio del siglo actual ha destacado la aparición de varias enfermedades virales de relevancia mundial, siendo la enfermedad provocada por el SARS-CoV2 la más importante de ellas (COVID-19). La comunidad científica y los distintos países no estaban preparados para un desafío de esta envergadura. Desde el punto de vista de la reumatología se desconoce las implicancias de este nuevo virus en los pacientes con enfermedades reumatológicas y sus tratamientos. Como reumatólogos nos encontramos frente a una oportunidad única de participar activamente para disipar esas interrogantes.

Pandemics have been inherent to our condition as inhabitants on this planet. Several viral diseases of worldwide concern have been reported since beginning of the actual century, being COVID-19 due to SARS-CoV2 the most important. The scientific community and the different countries have not been prepared for this kind of challenge. The potential issues about this novel virus and rheumatologic patients and their treatments are unknown. As rheumatologist we can actively participate in dissipate those questions.

Patterns of drug use and factors affecting adherence to medication in patients with rheumatoid arthritis: A prospective, observational, hospital- based study

Introduction: RA affecting ~ 1% of the world population, is associated with high level of non-adherence in clinical practice.The adherence to RA treatment therapy is affected by multiple factors. The present study evaluated the factors affectingadherence to medications among RA patients.Methodology: The prospective study was conducted from April 2014 to March 2015. Male and female subjects, aged≥18 years, and diagnosed with RA were included in the study. Demographic data, disease- and treatment-related data,adverse event profile and investigation data were obtained from all the participants. Adherence to medication of thesubjects was measured using adherence questionnaire. All the subjects were followed up at one month and at the end of6 months. McNemar’s test was used to analyse the difference in adherence from baseline to follow up. All the statisticalanalyses were performed using SPSS statistical software, version 17.0.Results: The study included 124 subjects, with a male to female ratio of 0.25:1, mean age of 45 years and RA duration of5 years. Mono and combination drug therapies were used in 59.1% and 41.9% of the subjects respectively. Methotrexatewas the most frequently used drug as a part of the regimen (82.3%). Among the subjects, 88 (71%) were found to beadherent. The comparison of various factors revealed significant difference only for the duration of RA (P 0.04).Conclusion: The adherence to antirheumatic medications among RA patients remains moderate and factors such asrural residence and older age (>45 years) can be associated with good adherence to RA medication. The study alsocorroborates the previous literature evidence suggesting methotrexate as the commonly used drug for managing RA.

Cost-minimization analysis of biological disease-modifying antirheumatic drugs in the Brazilian public health system (SUS) considering patients' weight / Análise de custo-minimização de medicamentos modificadores de curso da doença biológicos no Sistema Único de Saúde (SUS) no Brasil considerando o peso dos pacientes

Objective: To perform a cost-minimization analysis comparing the cohort with the current average patient weight of 70 kg (MoH current assumption). Since most rheumatoid arthritis (RA) patients in Brazil are women (60 kg or less), we also aimed to define this percentage at Brazilian public healthcare system (SUS). Methods: Treatment-naïve RA patients using biologics from January 2008 to November 2018 were retrieved from Datasus as well as the number of patients ≤ 60 kg and their drug use distribution. Data on drug costs were assessed from the last payment reported by MoH and then recalculated using the weighted average of 60 kg and a 52-weeks a year to assess cost-minimization. Results: In the studied cohort, 33,646 patients (33.3%) were classified as ≤ 60 kg. Annual cost per patient, considering an average weight of 60 kg, ranged from 2,872,29 USD to 4,223.93 USD. Tocilizumab 80 mg was the only drug demonstrating a reduction in annual cost per patient (-526.79 USD). Conclusion: Cost-minimization analysis based on weight-dependent dosage showed that tocilizumab could reduce MoH costs with RA treatment in 14.28%. By adopting weight-dependent dose of 60 kg, the Brazilian government could save up to 916,651.31 USD per year using tocilizumab versus other biological disease-modifying antirheumatic drugs (DMARDs). In ten years, it represents an accumulative saving of 9,166,513.57 USD.

Objetivo: Realizar uma análise de custo-minimização comparando a coorte com o peso médio de pacientes de 70 kg (atual premissa do Ministério da Saúde ­ MS). Como a maioria dos pacientes são mulheres (≤ 60 kg), também se objetivou definir esse percentual no sistema público de saúde brasileiro (SUS). Métodos: Pacientes com artrite reumatoide (AR) virgens de tratamento utilizando biológicos de janeiro/2008 a novembro/2018 foram retirados do Datasus, assim como o número de pacientes com ≤ 60 kg e a distribuição de uso das drogas. Os custos dos medicamentos foram avaliados a partir do último pagamento relatado pelo MS e recalculados utilizando a média de 60 kg e um ano de 52 semanas para estimar a custo-minimização. Resultados: Na coorte estudada, 33.646 pacientes (33,3%) foram classificados com ≤ 60 kg. O custo anual por paciente, considerando o peso médio de 60 kg, variou de 2.872.29 a 4.223,93 USD. Tocilizumabe 80 mg foi o único que demonstrou redução no custo anual por paciente (-526,79 USD). Conclusão: A custo-minimização baseada em dose peso-dependente mostrou que o tocilizumabe poderia reduzir os custos do MS no tratamento de AR em 14,28%. Ao adotar o peso de 60 kg, o governo poderia economizar até 916.651,31 USD ao ano utilizando tocilizumabe vs. outros medicamentos modificadores do curso da doença biológicos (MMCDb). Em 10 anos, isso representa uma economia acumulada de 9.166.513,57 USD.

Assessment of adverse drug reaction profile of the disease-modifying anti-rheumatic drugs at the department of orthopaedics in a tertiary care hospital, Silchar, Assam, India

Background: The mainstay of treatment of Rheumatoid Arthritis (RA) is the use of the disease-modifying anti-rheumatic drugs (DMARDs). Methotrexate, sulfasalazine and hydroxychloroquine are some of the DMARDs which are used in combination for the treatment of RA. The current study was undertaken to assess the adverse drug reactions (ADRs) of DMARDs that are commonly encountered with the treatment of RA.Methods: The present study was designed as a prospective, observational study on newly diagnosed patients with RA. Patients diagnosed with RA above 18 years (excluding pregnant women) of either sex who were prescribed DMARDs in combination were included. ADRs reported spontaneously by the patients and also responses obtained in a questionnaire related to likely ADRs from the patients was recorded in the case record form. Statistical analysis was done using graph pad and p value <0.05 was considered to be statistically significant.Results: A total of 47 patients attending the Outpatient Department of Orthopaedics, Silchar Medical College and Hospital, Silchar, Assam, India were screened for the study. ADRs were monitored up to the last visit on 41 patients excluding the patients who were lost and who were not able to adhere to the treatment. A total of 27 ADRs were reported from 19 ADR forms. Gastrointestinal manifestations were the most common adverse effects of combination DMARDs seen in 10 patients (24.39%). Severity assessment done using modified Hartwig and Siegel scale that showed majority of the ADRs were mild (74.07%).Conclusions: Present study showed that DMARDs are well-tolerated and have an acceptable toxicity profile as majority of ADRs seen were mild. It was however difficult to prevent the occurrence of ADRs. Proper monitoring of therapy is needed for early recognition of ADRs.

A Study Of Drugs Being Prescribed To The Patients Of Rheumatoid Arthritis Attending The Rheumatology Outpatient Department In A Tertiary Care Teaching Hospital: A Prospective Observational Study

INTRODUCTION - Drug utilization studies assess appropriateness of pharmacotherapy. Rheumatoid arthritis (RA) is an autoimmune disease, which, if untreated, may result in degradation of joints. OBJECTIVE - To evaluate the prescribed drugs according to WHO drug use indicators. METHODS - Data collected included Demographics, details of medications prescribed for RAand other co-morbidities. RESULTS – Average no of drugs per prescription were 4.98 ± 1.21. Methotrexate was prescribed to every patient. Percentage of patients prescribed Single DMARD, Two DMARDS and Three DMARDS were 10%, 48% and 42% respectively. 99.38% and 90.68% of the Drugs for RA were prescribed from NLEM 2015 and 20th WHO Model List of Essential Medicines (March 2017) respectively.75.9% drugs were prescribed by Generic name. CONCLUSION –The standard treatment guidelines for treatment of RAare followed. Drugs were mostly prescribed from the Essential drug lists. Majority of the drugs have been prescribed by generic names.

Rheumatoid Arthritis : An Understanding In The Light Of Herbal Medicines

Rheumatoid arthritis (RA) is characterised by chronic polyarticular synovial inflammation and progressive erosion of cartilage and bone. The disease occurs at any age, but is common among those aged between 40-70 years. RA has a worldwide distribution with prevalence of 1 to 2%. Pathogenesis of RA remains a mystery for past 40 years. Genetic studies established that people who carry specific MHC haplotypes show a higher risk for RA. Cytokines have also been implicated as important mediators of disease. Analysis of cytokine mRNA and protein in RA tissue revealed that TNF-, IL-1, IL-6, GM-CSF, and IL-8 are abundant. Reactive oxygen species (ROS) and Reactive nitrogen species (RNS) influences the inflammatory molecules. Antioxidants (exogenous or endogenous) are the compounds which prevent the generation of toxic oxidants. Treatment choice of the physician for RA is Non steroidal anti-inflammatory drugs (NSAIDs) and Disease modifying anti-rheumatic drugs (DMARDs). Herbal medicine is one of the oldest and traditional medicine systems around the world. Herbal products may contain a single herb or combinations of different herbs believed to have complementary effects. These contain potent bioactive substances.

Adherencia al tratamiento de pacientes con artritis reumatoidea que reciben medicamentos biológicos / Treatment adherence in patients with rheumatoid arthritis receiving biologics

Introducción: Al igual que en otras enfermedades crónicas, la adherencia al régimen terapéutico de los pacientes con artritis reumatoidea (AR) es baja (entre 30 y 80%), dependiendo de la definición de adherencia y de la metodología empleada para medirla. En este estudio se propone determinar el nivel de adherencia al tratamiento en pacientes con AR que reciben DMAR biológicas e identificar factores asociados a la falta de cumplimiento a la terapia. Material y métodos: Se realizó un estudio analítico, observacional de corte transversal en donde se incluyeron pacientes consecutivos con AR según criterios de clasificación (ACR’87) que se encontraban recibiendo fármacos biológicos para el tratamiento de su enfermedad en los últimos seis meses y que asistieron a la consulta ambulatoria. Para la valoración de la adherencia a DMAR se utilizaron los cuestionarios CQR (Compliance Questionnaire on Rheumatology) y el cuestionario SMAQ (Simplified Medication Adherence Questionnaire). Resultados: Se encuestaron 345 pacientes. Mediante el cuestionario SMAQ se observó una adherencia del 50% (159 pacientes). El Cuestionario CQR tuvo un puntaje mediano de 78 puntos (RIC 67-86). El 47% (147 pacientes) fueron adherentes (CQR >80). Sobre los pacientes incluidos, 151 (48%) refirieron no haber tenido ningún retraso, pérdida o adelanto de la dosis del biológico en los últimos 6 meses de tratamiento. El 52% no adherentes tuvo como causas: 146 (46%) pérdida de al menos una dosis del biológico con una mediana de dosis perdidas de 2 (RIQ: 1-3); 117 (37%) tuvo al menos un retraso en las dosis del biológico y 8 (2%) delantó la dosis. Los factores asociados al no cumplimiento de la terapia biológica fueron el tipo de cobertura médica, que el paciente no haya notado mejoría y la esperanza de una rápida respuesta al tratamiento, y la falta de adherencia a DMAR

Introduction: As in other chronic diseases, adherence to the therapeutic regimen of patients with rheumatoid arthritis (RA) is low (between 30 and 80%), depending on the definition of adherence and the methodology used to measure it. This study aims to determine the level of adherence to treatment in patients with RA who receive biological DMARs and to identify factors associated with non-compliance with therapy. MATERIAL AND METHODS: An observational, cross-sectional, observational study was performed in which consecutive patients with RA according to classification criteria (ACR'87) who were receiving biological drugs for the treatment of their disease in the last six months were included Attended the outpatient appointment. The CQR (Compliance Questionnaire on Rheumatology) and SMAQ (Simplified Medication Adherence Questionnaire) questionnaires were used to assess adherence to DMAR. Results: A total of 345 patients were surveyed. A 50% adherence (159 patients) was observed through the SMAQ questionnaire. The CQR Questionnaire had a median score of 78 points (RIC 67-86). 47% (147 patients) were adherent (CQR> 80). Regarding the patients included, 151 (48%) reported not having had any delay, loss or advancement of the biological dose in the last 6 months of treatment. The 52% of non-adherents had as causes: 146 (46%) loss of at least one dose of the biological with a median of doses lost of 2 (RIQ: 1-3); 117 (37%) had at least one biological dose delay and 8 (2%) delayed the dose. Factors associated with non-compliance with biological therapy were the type of medical coverage, the patient's perceived improvement and the expectation of a rapid response to treatment, and lack of adherence to DMAR.

Controlled Drug Delivery Approaches for Rheumatoid Arthritis.

A cure for rheumatoid arthritis is yet to be discovered. Although vast resources have been expended in the search for an immunological key to switch off the rheumatoid process, the most significant advances in the treatment of rheumatoid arthritis in recent times had come from gaining better understanding and skill in the safe use of existing disease modifying antirheumatic drugs (DMARDs). If prescribed appropriately and combined with adequate patient education and monitoring, Disease modifying anti-rheumatic drugs are safe and effective tools in the treatment of rheumatoid arthritis. The step down approach has been proposed for the treatment of patients with recent onset rheumatoid arthritis who have clinical features predictive of an adverse prognosis. More efficient ‘targeting’ of drugs at the site of desired action should help to minimize the adverse effects of therapy. Ultimately the most efficient way of relieving pain and stiffness will be to prevent or suppress the inflammatory disorders which give rise to the symptoms. Unfortunately this is a goal at present.

Medical treatment of rheumatoid arthritis (I): Nonsteroidal anti-inflammatory drugs, disease modifying antirheumatic drugs and glucocorticoids

The medical treatment of rheumatoid arthritis has been dramatically improved with the advances of newer disease-modifying antirheumatic drugs (DMARDs) and biologic agents during previous decades. To prevent joint damage, it is essential to start DMARD treatment early, especially within the first 3 months after diagnosis. Tight control of disease activity, and the thorough monitoring of the treatment's efficacy and the side effects of medications are also important. Nonsteroidal anti-inflammatory drugs (NSAIDs) are usually used to control pain and swelling of the joints. However, these drugs cannot alter the disease course of rheumatoid arthritis. It is therefore necessary to introduce DMARDs at the beginning of treatment, and, after achieving the effect of DMARDs, NSAIDs should be tapered as soon as possible. The main treatment should be DMARDs, which must be used wisely and appropriately. It is also important to adjust DMARD therapy during the course of treatment according to disease activity. Glucocorticoids have potent anti-inflammatory effects and can control inflammation dramatically. However, because of the diverse and serious side effects of glucocorticoids, the usage of glucocorticoids should be limited to low-dose oral therapy or intra-articular injection, unless otherwise indicated. Along with biologics, there are now various weapons available against rheumatoid arthritis, and it can be treated much more effectively than before.

Update on rheumatoid arthritis / 대한내과학회지

No abstract available.

Recent Advance in Rheumatoid Arthritis

ARheumatoid arthritis is a systemic, inflammatory, autoimmune disorder of unknown origins. Enhanced understanding of molecular pathogenesis has enabled the development of new biologic treatment that focuses on selective parts of immune system. Combined genetic and environmental factors in association with the risk of rheumatoid arthritis have received increased attention. Research undertaken on the longitudinal disease process and molecular pathology of joint inflammation has contributed to the development of new therapeutic strategies that promote early use of disease-modifying anti-rheumatic drugs (DMARDs) with tight disease control and measurable treatment outcome. Such approach can be beneficial for control of inflammatory activity and joint destruction. We need to find out how to tailor the best individualized treatment in accordance with different cases.

Recent Advance in Rheumatoid Arthritis

ARheumatoid arthritis is a systemic, inflammatory, autoimmune disorder of unknown origins. Enhanced understanding of molecular pathogenesis has enabled the development of new biologic treatment that focuses on selective parts of immune system. Combined genetic and environmental factors in association with the risk of rheumatoid arthritis have received increased attention. Research undertaken on the longitudinal disease process and molecular pathology of joint inflammation has contributed to the development of new therapeutic strategies that promote early use of disease-modifying anti-rheumatic drugs (DMARDs) with tight disease control and measurable treatment outcome. Such approach can be beneficial for control of inflammatory activity and joint destruction. We need to find out how to tailor the best individualized treatment in accordance with different cases.

Análise de custo do tratamento medicamentoso da artrite reumatóide / Cost analysis of drug therapy in rheumatoid arthritis

Com o objetivo de comparar custos de tratamento para artrite reumatóide com medicamentos modificadores do curso da doença (DMARDs) por um período de 48 meses, foram estudadas cinco diferentes etapas de tratamento fundamentadas em protocolos clínicos recomendados pela Sociedade Brasileira de Reumatologia com cinco ciclos de tratamento. Foi aplicado modelo analítico de decisão baseado na Análise de Markov, considerando as probabilidades do permanecer em algumas destas etapas ou transitar entre elas de acordo com a resposta à terapia. Foram usados os custos diretos com medicamentos, matérias médico-hospitalares para sua administração e exames laboratoriais necessários para o monitoramento do paciente. O modelo revelou que o ciclo que representa o uso do metotrexato em monoterapia foi o mais custo/efetivo (R$ 113.900,00 por paciente em 48 meses), seguido pelo paciente refratário (R$ 1.554.483,43), aquele que utiliza a tripla terapia e depois o biológico (R$ 1.701.286,76), o paciente intolerante ao metotrexato (R$ 2.629.919,14), e por fim o resultado daquele que iniciaria o tratamento já com o infliximabe mais metotrexato (R$ 9.292.879,31). A análise de sensibilidade demonstrou que os resultados encontrados são robustos, mesmo com a variação da eficácia do metrotrexate e do infliximabe.

With the aim to compare the cost of treatment for rheumatoid arthritis therapy with desease-modifying antirheumatic drugs (DMARDs) for a 48-month period, were studied five different treatment stage based on clinical protocols recommended by the Brazilian Society of Rheumatology, and then five therapy cycles. The analytical model based on the Markov Analysis, considered chaces for the patient continue in some stages or change between them according with a positive effect on outcomes. Only direct costs were comprised in the analyzed data, like drugs, materials and tests used for monitoring these patients. The results of the model show that the stage in with metotrexato drug is used like monotherapy was cost-effective (R$ 113,900.00 for patient during 48 months), followed by refractory patient (R$ 1,554,483.43), those that use therapy triplicate followed by infleximabe drug (R$ 1,701,286.76), the metotrexato intolerant patient (R$ 2,629,919.14), and final the result from that use metotrexato and infliximabe in the beginning (R$ 9,292,879.31). The sensitivity analysis confirm this results, when alternate the efficacy of metotrexato and infliximabe.

Cross-sectional study of the clinic behavior and therapeutic status of rheumatoid arthritis patients / 中华风湿病学杂志

Objective To investigate and analyze the behavior and therapeutic status of rheumatoid arthritis (RA) patients. Methods Out patients diagnosed with rheumatoid arthritis in our hospital from May to August 2007 were enrolled. The data including sex, age of onset, site of first hospitalization and medication status were collected and analyzed. Results In this 181 RA patients, the mean age of onset was (53±11) year-old, mean history duration was (10±8) years, the ratio of male to female was 1:4.2. The orthopedics department was the most common site of first hospital visit (32.0%, 58/181) and rheumatology department was the most common site to clarify the diagnosis (62.4% ,113/181). The diagnosis delay caused by patients themselves was (5.9±17.2) months and the delay caused by doctors was (9.0±22.0) months. More than half of the patients were not treated appropriately before they came to our hospital. Methotrexate was the most commonly used DMARDs (67.3%), followed by leflunomide (46.4%), sulfasalazine (37.5%) and hydroxyehloroquine (19.6%). Conclusion In this cohort, the proportion of patients who come to rheumatology department immediately after disease onset is low. There is delay between symptoms and final diagnosis. More than half of the patients are not treated appropriately.