Practices, strategies, and motivations in treatment of rheumatoid arthritis

National Analysts conducted primary research with rheumatologists--specifically, two panel discussions, 25 in-depth telephone interviews, and a mail survey of conference (Auranofin Symposium and Workshop) participants--to examine current treatment practices and to probe the rationale and motivations underlying treatment strategies in rheumatoid arthritis. The research identified important areas of consensus in drug perceptions, therapeutic approaches, and disagreements. Physicians differ regarding the minimum time they wait after diagnosing rheumatoid arthritis before initiating remittive therapy, some beginning immediately and others waiting six months or longer. Younger physicians are quicker to initiate remittive treatment than their older colleagues, but both younger and older practitioners are initiating remittive therapy earlier than in the past. Some noteworthy differences between hospital-based and office-based practitioners were discerned with respect to factors that figure in their decisions to initiate remittive therapy. Differences were also found among physicians in the way they pose drug options to their patients; "authoritarian," "libertarian," and "guided democracy" were names given to the three styles identified. In general, however, physicians report that patients are more directly involved in treatment selection than previously, a trend that may in part be due to the use of more aggressive treatment strategies than in the past and a desire to share the psychologic burden of those decisions. Findings suggest that gold compounds will continue to be a mainstay first-line disease-modifying agent in the treatment of rheumatoid arthritis but that there may be less reluctance to use other agents as physicians become increasingly familiar and comfortable with alternative options, especially penicillamine and immunosuppressive agents.