Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Practice Patterns of US Rheumatologists Related to Diagnosis and Assessment of Disease Activity as Well as Switching Biologic Therapies in Rheumatoid Arthritis.
DiBonaventura2, Marco, Roy1, Sanjoy, Ertl2, Jochen, Cifaldi1, Mary A.
Background and Purpose:
This study investigated measures used by US rheumatologists to diagnose RA and assess disease activity. We also describe the treating rheumatologists' practice patterns for switching biologic therapies for patients who discontinued antitumor necrosis factor (anti-TNF) agents for any reason.
A sample of US rheumatologists (N=110) from the All Global physician panel were surveyed online. The All Global physician panel is an opt-in, actively managed, online panel of several hundred thousand physicians in the US and Europe. Respondents were asked for demographic and practice information, as well as, about RA diagnostic and disease severity measures they were aware of and how often they used those measures. Responses for awareness and frequency of use were measured on a 5-point scale, where 1=never use and 5=always use.
Physicians were mostly men (n=81, 74%), fairly equally distributed between urban and suburban practices (suburban: n=58, 53%). The mean number of years in practice (post-residency) was 15.9, and the mean number RA patients seen per month was 143.1. The anticyclic citrullinated peptide antibody (anti-CCP) test had the greatest awareness and frequency of use as a diagnostic measure (97% of physicians aware of the test; mean frequency of use score±SD, 4.5±0.9). Regarding awareness and use of assessments of disease activity, swollen joint count was the most common (SJC; 89% of physicians aware; mean use±SD, 4.2±1.4). C-reactive protein (CRP) concentration, erythrocyte sedimentation rate (ESR), and tender joint count (TJC) were among the other measures with high awareness and frequent use. Magnetic resonance imaging (MRI) and Disease Activity Score (DAS), used as measures for diagnosis or assessment, had the largest discordance between high awareness and low use. White blood count (WBC) had the largest discordance between low awareness and high use, both as a diagnostic and an assessment measure. Assessment of their switching behavior showed that rheumatologists switched biologic therapies for 25% of their patients; 67% were switched to a second anti-TNF agent; the remainder were switched to a non-TNF biologic therapy. Approximately 75%, 69%, and 52% of patients were switched to a second anti-TNF agent when the first was etanercept, adalimumab, and infliximab, respectively.
The anti-CCP test and SJC were the most well-known and the most frequently used measures to diagnose RA and assess disease activity. MRI and DAS were well-known but rarely used in routine practice, whereas WBC was used relatively frequently despite low awareness of its value as a diagnostic tool. Rheumatologists switched therapy for a quarter of their patients who received biologic therapy, and the switch to a second anti-TNF was more frequent for subcutaneous anti-TNF agents compared with agents administered by intravenous infusion.
To cite this abstract, please use the following information:
DiBonaventura, Marco, Roy, Sanjoy, Ertl, Jochen, Cifaldi, Mary A.; Practice Patterns of US Rheumatologists Related to Diagnosis and Assessment of Disease Activity as Well as Switching Biologic Therapies in Rheumatoid Arthritis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :327