More Aggressive Drug Treatment of Rheumatoid Arthritis in a University-based Practice

We sought to assess the impact of recent observations and recommendations on the treatment of rheumatoid arthritis in a university-based rheumatology practice over a recent 6-year period. Data was collected from information recorded in a database by physicians treating patients in outpatient rheumatology clinics. The treatment regimens of all patients with rheumatoid arthritis seen during the first half of 1987 and 1993 were compared. The populations were similar in age, race, and sex distribution, disease duration, and seropositivity. Nonsteroidal anti-inflammatory drug use decreased from 85% to 74%, while corticosteroid use increased from 31% to 44% of patients. Second-line agent use increased from 46% to 65% of patients, all of which could be accounted for by the increase in methotrexate use from 11% to 32%. The use of other second-line agents remained stable (hydroxychloroquine, auranofin, azathioprine), declined (intramuscular gold, penicillamine), or increased slightly (sulfasalazine). An increase in combination second-line drug therapy from 2% to 6% was noted. This study shows that between 1987 and 1993, our drug therapy for rheumatoid arthritis has become more aggressive: we have increased steroid use, decreased nonsteroidal use, and more frequently used second-line agents, particularly methotrexate.