ABSTRACT
OBJECTIVES: Methotrexate (MTX) is the first choice in the treatment of rheumatoid arthritis (RA), but the doses and regimens vary significantly. For this purpose, we conducted an observational study on the use of MTX for RA in Italy (MARI study). METHODS: The MARI study included 1,327 RA patients on MTX treatment for at least 12 months, at 60 Italian rheumatology units. Concomitant medications with corticosteroids, other DMARDs or biological therapies were recorded. The clinical assessment included the Disease Activity Score 28 (DAS28) and the serological positivity for the rheumatoid factor or for the anti-citrullinated protein antibodies. RESULTS: The included patients were treated with either oral (n=288) or parenteral (n=1039) MTX. Only 15.5% of the total number of the patients was on adequate MTX dose (i.e. ≥ 15 mg for the oral route of administration and >12 mg for the parenteral one). The initially established MTX dose was modified in 37.1% of the patients, for intolerance or clinical criteria. A DAS28 remission (DAS28 <2.6) was observed only in 58.5% of the cases, while 52.9% of the patients still presenting an active form of the disease were on suboptimal doses of MTX. CONCLUSIONS: The weekly dose of MTX prescribed for the treatment of RA is often suboptimal, even in conditions of inadequate control of the disease activity. The recommendations for the use of MTX in RA patients should take into account the efficacy and tolerability data derived from its use in real clinical practice.
Subject(s)
Arthritis, Rheumatoid/drug therapy , Glucocorticoids , Methotrexate , Aged , Antirheumatic Agents/administration & dosage , Antirheumatic Agents/adverse effects , Arthritis, Rheumatoid/blood , Arthritis, Rheumatoid/diagnosis , Arthritis, Rheumatoid/epidemiology , Arthritis, Rheumatoid/physiopathology , Dose-Response Relationship, Drug , Drug Therapy, Combination , Female , Glucocorticoids/administration & dosage , Glucocorticoids/adverse effects , Humans , Italy/epidemiology , Male , Methotrexate/administration & dosage , Methotrexate/adverse effects , Middle Aged , Patient Acuity , Remission Induction/methods , Rheumatoid Factor/blood , Treatment OutcomeABSTRACT
One-hundred and eighteen patients with rheumatoid arthritis were treated for 4 weeks with flurbiprofen 300 mg/day (sixty patients) or naproxen 750 mg/day (fifty-eight patients) in a six-centre randomized trial. Flurbiprofen proved to be more effective than naproxen in reducing morning stiffness (p less than 0.01), Ritchie articular index (p less than 0.01) and number of swollen joints (p less than 0.05) and in relieving night pain (p less than 0.01). The incidence and severity of side-effects, mainly gastric, were both low and similar with flurbiprofen (17%) and naproxen (19%).
