Clinical evaluation of a cohort of patients with rheumatoid arthritis treated with anti-TNF-alpha in the community

Objectives. - TNF-alpha inhibitors have been effective in randomized controlled studies for the treatment of RA. The purpose of this study was to evaluate the clinical, laboratory, and radiological responses in a cohort of unselected patients with RA treated with TNF-a inhibitors in the community. Methods. - Using the Swiss Clinical Quality Management in Rheumatoid Arthritis, a centralized system of data gathering for RA patients, we obtained the following information regarding patients treated with a TNF-a inhibitor in the Geneva Canton before 02/2003: demographics; clinical data (disease activity, functional status, treatments received and type of TNF-a inhibitor used); laboratory and radiographic data. Results. - A total of 66 patients (mean age = 60.5 years) with long-standing disease (mean duration = 12.5 years) were analyzed. Sixteen patients (24%) discontinued anti-TNF-alpha, half within the first 6 months of the study. Mean DAS score decreased from 4.8 +/- 0.4 to 3.8 +/- 0.4 (P < 0.01); HAQ scores (mean = 1.35) remained unchanged; pain, evaluated on a 10-point scale, decreased from 5.0 at baseline to 3.3 (P < 0.001). CRP values decreased steadily from 17.9 at baseline to 5.6 at 20 months or later. The progression of radiographic damage decelerated in 30 patients, accelerated in 12, and remained unchanged in one. Conclusions. - The responses of this community-based group of patients with severe, long-standing RA to TNF-alpha inhibitors revealed a reassuring similarity to those of patients enrolled in controlled clinical trials. (c) 2005 Elsevier SAS. All rights reserved.