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Effectiveness of a clinical practice intervention in early rheumatoid arthritis
Author(s) -
Descalzo Miguel Ángel,
Carbonell Jordi,
GonzálezÁlvaro Isidoro,
Sanmartí Raimon,
Balsa Alejandro,
HernandezBarrera Valentín,
RománIvorra José Andrés,
IvorraCortés José,
Lisbona Pilar,
Alperi Mercedes,
JiménezGarcia Rodrigo,
Carmona Loreto
Publication year - 2012
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.20682
Subject(s) - medicine , rheumatoid arthritis , cohort , physical therapy , confidence interval , rheumatology , cohort study , arthritis
Objective To compare the outcome of early rheumatoid arthritis (RA) patients in a country where early clinics were established versus the outcome of patients in nonprotocolized clinics. Methods We compared 2 multicenter cohorts: an RA cohort derived from an early arthritis registry set in 36 reference hospitals in which a specific intervention was established (Evaluation of a Model for Arthritis Care in Spain [SERAP]), and a historical control cohort of patients with early RA attending 34 rheumatology departments (Prognosis in Rheumatoid Arthritis [PROAR] cohort). Effectiveness was tested by comparing the change in the Disease Activity Score in 28 joints (DAS28), the change in the Health Assessment Questionnaire (HAQ), and the change in the Sharp/van der Heijde radiologic score using marginal structural models. Results A total of 161 early RA patients were recruited in the PROAR cohort and 447 in the SERAP cohort. Being a SERAP patient was inversely correlated with activity, resulting in a decrease of −0.24 (95% confidence interval [95% CI] −0.39, −0.08) units in the population average of the DAS28 after adjustment was made. Moreover, intervention may be seen as a protective factor of radiologic damage, with a decrease of −0.05 (95% CI −0.09, −0.01) units in the logarithm of the total Sharp/van der Heijde score. On the other hand, a decrease in functional impairment was detected, but intervention was not statistically associated with HAQ changes. Conclusion Preventing major radiographic progression in a 2‐year term inside structured and organized special programs for the management of disease, such as early arthritis clinics, are effective compared to nonprotocolized referrals, treatment, and followup.