Original paper
The management of patients with rheumatoid arthritis in everyday clinical practice of rheumatologists: the results of a Polish nation-wide questionnaire study

Objective: The aim of the study was to establish the diagnostic and therapeutic approach to patients with rheumatoid arthritis in the everyday clinical practice of rheumatologists.
Material and methods: A questionnaire study was conducted in rheumatologists across the country. Questions were related to the diagnosis and therapy of rheumatoid arthritis regarding the use of non-biological and biological disease-modifying anti-rheumatic drugs. Results: Data were collected from 170 physicians. The evaluation of rheumatoid arthritis activity by physicians is based on data from the patient’s history and physical examination (swollen and tender joints count, duration of morning stiffness), DAS28 index, HAQ-DI questionnaire and laboratory data (CRP, ESR, blood cell count). According to 75% of physicians, high disease activity persists in 10-30% of patients, regardless of the applied treatment. Seventy-nine percent of physicians declare remission in less than 40% of patients. Methotrexate in a dose of 15-20 mg per week is the most frequently administered non-biological disease-modifying anti-rheumatic drug, both in monotherapy and in combination. Combined therapy including at least 2 non-biological disease-modifying anti-rheumatic drugs is used in 15-45% of patients. Biological agents are considered as effective in the treatment of rheumatoid arthritis. They are given to 5% of patients although the majority of physicians declare that biological treatment is required in 10 to 30% of patients. The main obstacles for biological agent administration are: lack of availability, high price and risk of adverse events. Physicians expect from biological agents proven efficacy and safety, confirmed in clinical trials, as well as easy administration. Simplification of the procedures, permanent and stable information on therapy funding, and safety and efficacy proven in long-lasting clinical studies could enable access to biological therapy.
Conclusions: The majority of physicians in their everyday clinical practice use well-established rules of diagnostics and treatment although the existing differences in interpretation of examination results and disease activity index indicate a need for further education and propagation of guidelines. Despite the applied treatment, a large group of patients does not reach remission, or the high disease activity persists. Methotrexate in monotherapy and combination treatment is the most commonly administered non-biological disease-modifying anti-rheumatic drug. After failure of non-biological disease-modifying drugs, physicians introduce biological therapy, which is considered as a very effective one enabling therapeutic goals to be achieved, albeit one available for only a limited number of patients who require such treatment.