Effect of adherence to European treatment recommendations on early arthritis outcome: data from the ESPOIR cohort

Abstract

Early arthritis patients whose treatment adhered to the 2007 EULAR recommendations seemed to benefit from such treatment in terms of risk of clinical and radiographic progression. Using a propensity score of being treated according to recommendations in observational studies may be useful in assessing the potential impact of these recommendations on outcome.

Level of agreement of the 1987 ACR and 2010 ACR/EULAR rheumatoid arthritis classification criteria: an analysis based on ESPOIR cohort data

“…Our results cannot be considered a validation of the 2010 criteria because the ESPOIR data have been used—among other cohort data—in the initial data-driven phase of the construction of the 2010 criteria 4. During this phase, the data for several early arthritis cohorts were used to identify and select the items that optimally revealed patients with ‘probable RA’, defined by a proxy: initiation of methotrexate within a couple of months after symptom onset, as now widely recommended,7–9 based on extensive scientific evidence 2 10–12. The first data-driven phase was then followed by an expert-based phase involving clinical vignettes to switch from the predictors of methotrexate initiation to predictors of RA diagnosis, regardless of the initiation of a specific DMARD 4 13.…”

Matrix to predict rapid radiographic progression of early rheumatoid arthritis patients from the community treated with methotrexate or leflunomide: results from the ESPOIR cohort

“…At the same time, regular adaptation of DMARDs depending on disease activity - that is, RA tight control - has become an additional standard in RA management to achieve at least low disease activity and, if possible, disease remission [3,6-12]. Implementation of these recommendations in practice has led to better clinical outcomes [6,8,13]. …”

Early lessons from the recent-onset rheumatoid arthritis cohort ESPOIR

“…Also under evaluation is the contribution of biologics, particularly TNF␣ antagonists, which were used during the first five years in about 22% of ESPOIR patients with RA. Several studies evaluated management strategies for recent-onset RA [23,[46][47][48][49][50][51]53]. The results confirmed the beneficial effects of early rheumatologist referral of patients with early arthritis; early administration of effective DMARD therapy, which decreased 1-year radiographic progression when started within three months after disease onset; and tight disease control based on a validated activity score to allow prompt treatment adjustments.…”

“…Finally, management strategies currently used in everyday practice are not always fully consistent with clinical practice [47]. This finding raises concern, since adhesion of patients and rheumatologists to recommendations such as those issued by the EULAR limits structural disease progression and functional impairments in RA [51].…”