RESEARCH - Ascendancy of weekly low-dose MTX in usual care of RA from 1980 to 2004

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Rheumatology Advance Access originally published online on August 7, 2008

Ascendancy of weekly low-dose methotrexate in usual care of rheumatoid

arthritis from 1980 to 2004 at two sites in Finland and the United

States

T. Sokka1 and T. Pincus2

1Jyväskylä Central Hospital, Jyväskylä, Finland and 2NYU Hospital for

Joint Diseases, NY, USA.

Abstract

Objectives. To analyse consecutive patients with RA in usual

rheumatology care between 1980 and 2004 at two settings for the

proportion of patients taking MTX, interval from patient presentation

to MTX prescription and radiographic and functional status outcomes.

Methods. Longitudinal study of all patients seen in usual care between

1980 and 2004, 1982 consecutive patients in Jyväskylä, Finland and 738

consecutive patients in Nashville, TN, USA. Clinical status was

assessed as Larsen radiographic scores in Jyväskylä and modified

health assessment questionnaire (MHAQ) in Nashville.

Results. The probability of initiating MTX within 5 yrs after

presentation increased from <5% in Jyväskylä before 1989 to >90% in

2000–04, and from 25% in Nashville in 1980–84 to >90% since 1995. The

median interval from presentation to MTX initiation in Jyväskylä was

14 yrs in 1980–84 vs 8.6 in 1985–89, 4.5 in 1990–94, 1.8 in 1995–99

and <1 yr in 2000–05; in Nashville, median intervals were 8.6 yrs in

1980–84, 4.4 years in 1985–89, and <2 months in 1990–95, 1995–2000 and

2000–05. Patient outcomes were substantially improved in both

settings: in Jyväskylä, mean 5-yr Larsen radiographic scores (0–100)

were 15.7 in 1980–84 vs 4.0 in 1995–99; in Nashville, mean MHAQ scores

(0–3) for physical function were 1.13 in 1980–84 vs 0.57 in 2000–04.

Conclusion. Early MTX in usual clinical care of RA increased from <5%

in 1980 to >90% in 2004. Over this period, substantially improved

outcomes were seen, most of which antedated biological agents.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/47/10/1543?etoc

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