Better Clinical Results in Rheumatoid Arthritis Patients Treated Under a Multidisciplinary Care Model When Compared with a National Rheumatoid Arthritis Registry

Figures & data

Figure 1 The rheumatoid arthritis multidisciplinary care model framework. The first visit within the model is lead by the rheumatologist; then. patients go through with the other health specialties. All the team participate in the management.

Table 1 Demographic and Clinical Characteristics of the Study Cohorts

Characteristics	Specialized CoE		National RA Registry		P-value
	(n=7053)		(n=81,492)
	n	%	n	%
Sex
Female	5753	81.57	68,387	83.92	<0.001
Male	1300	18.43	13,105	16.08	0.061
Age in years. Median (Range)	62 (53–70)		59 (50–67)		NA
Age in years at the time of diagnosis. Median (Range)	50 (40–60)		50 (39–59)		NA
Time in years of evolution of the disease. Median (Range)	8 (3–16)		6 (3–12)		NA
Comorbidities
Sjögren’s syndrome	355	5.03	6117	7.52	0.148
Osteoporosis	1820	25.80	15,834	19.46	<0.001
Chronic kidney disease	57	0.81	2531	3.11	0.027
Cardiovascular disease	310	4.40	2232	2.74	0.025
Diabetes mellitus	475	6.73	6531	8.02	0.436
Arterial Hypertension	2042	28.95	25,349	31.15	0.059
Body mass index (kg/m^2)
Low weight (<18.5)	261	3.97	2779	4.01	1.000
Normal weight (18.5–24.9)	2904	44.22	30,329	43.73	<0.001
Overweight (25.0–29.9)	2489	37.90	25,217	36.36	<0.001
Obesity (≥30)	913	13.90	11,025	15.90	0.386

Notes: n=6879 for the institutional registry (missing data of 2.47%) and n=69,350 for the National registry (missing data of 14.9%). P value pearson’s chi-square test.

Abbreviations: CoE, Center of Excellence; RA, Rheumatoid arthritis; NA, Not Available.

Table 2 Initial Tests in Incident Cases of Both Cohorts

Initial Laboratory and Radiographic Tests	Specialized CoE		National RA Registry		P-value
	(n=303)		(n=4766)
	n	%	n	%
ESR
Normal (≤ 20)	105	34.65	1344	28.20	0.159
Elevated (21–150)	163	53.80	1596	33.49	<0.001
No data	35	11.55	1826	38.31	0.001
Rheumatoid factor
Negative	64	21.12	893	18.74	0.638
Positive	215	70.96	2616	54.89	<0.001
No data	24	7.92	1257	26.37	0.041
Anti-CCP
Negative	77	25.41	715	15.00	0.017
Positive	197	65.02	1343	28.18	<0.001
No data	29	9.57	2708	56.82	<0.001
Hand X-ray
No erosions	141	46.53	1275	26.75	<0.001
With erosions	59	19.47	234	4.91	0.0002
No data	103	33.99	3257	68.34	<0.001
Foot X-ray
No erosions	138	45.54	858	18.00	<0.001
With erosions	30	9.90	132	2.77	0.075
No data	135	44.55	3776	79.23	<0.001

Note: P value pearson’s chi-square test.

Abbreviations: CoE, Center of Excellence; RA, rheumatoid arthritis; ESR, erythrocyte sedimentation rate; Anti-CCP, Anti-cyclic citrullinated peptides antibodies.

Table 3 Clinical RA Characteristics of the Population in Both Cohorts

Characteristics	Specialized CoE		National RA Registry		P-value
	(n=7053)		(n=81,386)
	n	%	n	%
Clinical studies (last semester)
ESR
Normal (≤ 20)	2211	31.35	28,689	35.25	0.0002
Elevated (21–150)	3049	43.23	25,315	31.10	<0.001
No data	1793	25.42	27,382	33.64	<0.001
ALT
Normal	4209	59.68	46,373	56.98	0.0007
Abnormal	1048	14.86	6832	8.39	<0.001
No data	1796	25.46	28,181	34.63	<0.001
Urinalysis
No proteinuria	4209	59.68	39,065	48.00	<0.001
With proteinuria	1048	14.86	1500	1.84	<0.001
No data	1796	25.46	40,821	50.16	<0.001
Hand X-ray
No erosions	4644	65.84	12,441	15.29	<0.001
With erosions	1220	17.30	4475	5.50	<0.001
No data	1189	16.86	64,470	79.22	<0.001
Foot X-ray
No erosions	5211	73.88	12,593	15.47	<0.001
With erosions	649	9.20	3259	4.00	<0.001
No data	1193	16.91	65,534	80.52	<0.001
Frequency of rheumatology consultations (per year)
No consultation	174	2.47	20,066	24.66	<0.001
1 a 3	1470	20.84	45,127	55.45	<0.001
4 a 6	4938	70.01	14,476	17.79	<0.001
More than 6	471	6.68	996	1.22	<0.001
No data	0	0.00	721	0.89	<0.001
Last RA activity status according to DAS28
Remission	3948	55.98	25,337	31.13	<0.001
Low activity	1115	15.81	7143	8.78	<0.001
Moderate activity	1572	22.29	9895	12.16	<0.001
High activity	238	3.37	2539	3.12	0.7993
No data	180	2.55	36,472	44.81	<0.001

Note: P value pearson’s chi-square test.

Abbreviations: ESR, erythrocyte sedimentation rate; ALT, alanine aminotransferase; RA, rheumatoid arthritis; DAS28, Disease Activity Score 28 joints; CoE, Center of Excellence.

Table 4 Frequency of Use of Medications in Study Cohorts

Group of Medications	Specialized CoE		National RA Registry		P-value
	(n=7053)		(n=81,386)
	n	%	n	%
NO DMARDs
Non-opioid analgesics (acetaminophen – dipyrone)
Yes	3082	43.7	29,522	36.27	<0.001
No	3971	56.3	51,327	63.07	<0.001
No data	0	0	537	0.66	-
Opioid analgesics (codeine – tramadol)
Yes	1285	18.22	10,217	12.55	<0.001
No	5768	81.78	70,948	87.17	<0.001
No data	0	0	221	0.27	-
NSAIDs
Yes	102	1.45	9499	11.67	0.376
No	6951	98.55	71,530	87.89	<0.001
No data	0	0	357	0.44	-
Corticosteroids
Yes	4234	60.03	39,540	48.583	<0.001
No	2819	39.97	41,265	50.703	<0.001
No data	0	0	581	0.714	-
Calcium
Yes	2969	42.1	35,403	43.5	0.139
No	4084	57.9	45,525	55.94	0.015
No data	0	0	458	0.56
Vitamin D
Yes	2979	42.24	37,557	46.15	<0.001
No	4074	57.76	43,467	53.41	<0.001
No data	0	0	362	0.44	-
Conventional csDMARDs
Azathioprine	87	1.23	898	1.1	0.912
Cyclophosphamide	2	0.03	62	0.08	0.980
Cyclosporine	20	0.28	168	0.21	0.949
Chloroquine	896	12.7	13,107	16.1	0.007
D-penicillamine	3	0.04	16	0.02	0.983
Hydroxychloroquine	82	1.16	1959	2.41	0.465
Leflunomide	2961	41.98	30,229	37.14	<0.001
Methotrexate	4536	64.31	43,073	52.92	<0.001
Sulfasalazine	1249	17.71	9327	11.46	<0.001
Biological DMARDs and small molecules
Abatacept	156	2.21	2465	3.03	0.559
Adalimumab	110	1.56	1384	1.7	0.912
Certolizumab	292	4.14	1759	2.16	0.042
Etanercept	228	3.23	3023	3.71	0.710
Golimumab	123	1.74	889	1.09	0.529
Infliximab	72	1.02	193	0.24	0.399
Rituximab	128	1.81	2170	2.67	0.554
Tofacitinib	80	1.13	1050	1.29	0.902

Note: P value pearson’s chi-square test.

Abbreviations: csDMARDs, conventional Disease Modifying Antirheumatic Drugs; NSAIDs, Non-steroidal anti-inflammatory drugs; RA, rheumatoid arthritis.