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Rheumatology Advance Access published online on August 7, 2008
Rheumatology, doi:10.1093/rheumatology/ken316
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© 2008 The Author(s)
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/2.0/uk/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Correspondence to: T. Pincus, NYU Hospital for Joint Diseases, 301 East 17 Street, New York, NY 10003, USA. E-mail: tedpincus{at}gmail.com


  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.

KEY WORDS: Rheumatoid arthritis, Health assessment questionnaire, Modified health assessment questionnaire, Methotrexate, Outcomes

Submitted 22 February 2008; revised version accepted 7 July 2008.
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