Disease Modifying Anti-Rheumatic Drugs [Dmards] Used and Treatment Outcome of Rheumatoid Arthritis in Rheumatology Clinic, Srinagarind Hospital
Pimchanok Tantiwong MD1, Ratanavadee Nanagara MD1, Chingching Foocharoen MD1, Ajanee Mahakkanukrauh MD1, Siraphop Suwannaroj MD1
Affiliation : 1 Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Objective : To describe the pattern of DMARD used, treatment outcome, and factor affecting treatment outcome in RA
patients treated at rheumatology clinic, Srinagarind Hospital, KhonKaen Universtiy.
Materials and Methods : Cross-sectional study was performed on data base of 359 RA patients who met 1987 ACR or 2010
Rheumatoid Arthritis Classification criteria for RA. We included patients older than 18 years-old who has been treated with
>1 DMARDs for at least 1 year. Demographic data, co-morbidities, articular and extra-articular manifestations, current
DMARDs used, DMARDs used during achieving treatment target, Disease activity score of 28 joints (DAS 28), laboratory
and radiographic results was collected from RA database.
Results : Mean age of onset was 45 (SD+12.8) years with median disease duration of 12.4 (IQR 7.3 to 17.5) years. 338
(94.1%) of overall RA patients received conventional synthetic DMARDs [csDMARD], meanwhile based on reimbursement
type, 9 out of 202 (4.45%) received biologic DMARDs [bDMARDs]. The most frequently use DMARD was methotrexate
[MTX]. Currently 155 (43.2%) out of 359 were treated with 2 DMARDs, while 148 (41.2%) had DMARD monotherapy.
Disease activity among patients received only csDMARD(s) was scored as low (<3.2), moderate (>3.2 to 5.1), and high
(>5.1) at the proportion of 44.4, 45.8, and 8.2% respectively. Number of patients who had received and recieved bDMARDs
was small (21 cases). Among these, 76.2% were good responders of which 50% achieved treatment target, and (25%) had
drug free remission. Only 4.5% needed long term bDMARDs of which 38.1% had low disease activity [LDA] and 61.9% had
moderate DAS. Low dose corticosteroid [LDCS] was overall prescribed in 63.5%. In csDMARDs group, its use was related
with higher DAS; 52.3, 69.7, and 82.1% among patients having low, moderate, and high DAS. In patients who achieved
treatment target, 61.8% had sustained remission/LDA >1 year. Factors associated with achieving target were history of
having remission, induction with MTX, and early remission after DMARDs initiation.
Conclusion : In this RA cohort, 94.1% received only csDMARD and 4.45% received long term bDMARD. 43.7% of
csDMARD group and 38.1% of bDMARD group currently achieved treatment target. None of bDMARD group had high
DAS. LDCS was overall prescribed in 63.5%. The factors associated with current LDA in RA patients were history of having
remission, induction with MTX, and achieving remission within the first year after DMARDs initiation.
Keywords : DMARDs, Outcome, Rheumatoid arthritis
