Regional and temporal variation in the treatment of rheumatoid arthritis across the UK: a descriptive register-based cohort study. Issue 6 (8th November 2012)

• Record Type: Journal Article
• Authors: Edwards, Christopher John; Campbell, Jennifer; van Staa, Tjeerd; Arden, Nigel K
• Is Part Of: BMJ open. Volume 2:Issue 6(2012)
• Publication Date: 2012-11-08
• Subjects: Primary Care -- Rheumatology; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2012-001603
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Objectives: To describe current disease-modifying antirheumatic drugs (DMARDs) prescription in rheumatoid arthritis (RA) with reference to best practice and to identify temporal and regional trends in the UK. Design: Descriptive, register-based cohort study. Participants: Permanently registered patients aged ≥18 years with a recorded diagnosis of RA between 1 January 1995 and 31 March 2010 and matched controls. Participants with RA were identified through screening of all patients in the General Practice Research Database (GPRD) with a clinical or referral record for RA and at least 1 day of follow-up. Setting: 639 general practices in the UK supplying data to the GPRD. Main outcome measures: Medication prescribing between 3 and 12 months of RA diagnosis by region and time period (1995–1999, 2000–2005 and 2006–April 2010). Results: Of the 35 911 patients in the full RA cohort, 15 259 patients (42%) had incident RA. Analysis of prescribing in incident RA patients demonstrated that between 1995 (baseline) and 2010 there was a substantial increase in DMARD, and specifically methotrexate, prescribing across all regions with a less marked increase in combination DMARD prescribing. Taking 12-month prescribing as a snapshot: DMARD prescribing was 19–49% at baseline increasing to 45–74% by 2006–April 2010; methotrexate prescribing was 4–16% at baseline increasing to 32–60%; combination DMARD prescribing was 0–8% at baseline increasing to 3–17%. However, there was marked regional variation in the proportion of RA patients receiving DMARD regardless of time period. Conclusions: There has been a substantial increase in prescribing of DMARDs for RA since 1995; however, regional variation persists across the UK with relative undertreatment, according to established best practice. Improved implementation of evidence-based best clinical practice to facilitate removal of treatment variation is warranted. This may occur as a result of the implementation of published national guidance.