DISEASE STATUS AT 1ST NOTIFICATION

STANDARD OF CARE PRELIMINARY REPORT: APRIL 2009 - AUGUST 2010 National Infl ammatory Arthritis Registry NIAR 28

5. STANDARD OF CARE

5.1 TIME TO INITIATION OF DMARDS AFTER DIAGNOSIS

A large propor on of pa ents were started on Disease Modifying An -Rheuma c Drugs DMARDS soon a er the diagnosis was made. This is in accordance with current treatment recommenda ons. 69.7 80 60 40 20 11.6 1months 1-6 months 6-12 months 12 months Unknown 3.3 11.6 11.6 Figure 16: Time to ini a on of DMARDS a er diagnosis Comparing professionals and non-professionals, there does not appear to be much di ff erence in terms of when treatment was started. 100 90 80 70 60 50 40 30 20 10 Professional N=100 Non-Professional N=862 5 5 15 75 11.72 3.25 12.88 72.12 12 months 6-12 months 1-6 months 1 months Figure 17: Time to ini a on of DMARDS a er diagnosis comparing professionals and non-professionals PRELIMINARY REPORT: APRIL 2009 - AUGUST 2010 National Infl ammatory Arthritis Registry NIAR 29

5.2 TYPES OF DMARDS USED

Methotrexate MTX being the anchor drug in the treatment of Rheumatoid Arthri s was used in 86.6 of pa ents. This was followed by sulphasalazine SSZ at 69.5 and hydroxychloroquine HCQ at 34.6. The use of Lefl unomide was 24.1. The other less commonly used drugs for example cyclosporine, penicillamine, azathioprine and cyclophosphamide were used in 2.7 of the pa ents. 100 86.6 69.5 24.1 34.6 2.7 MTX SSZ HCQ Others 90 80 70 60 50 40 30 20 10 Figure 18: Types of DMARDS used

5.3 USE OF COMBINATION DMARDS

697 of pa ents were on combina on DMARDS. The distribu on of pa ents using the various combina on DMARDS are shown in the fi gure below. MTX + SSZ MTX + Lefl unomide MTX + SSZ + HCQ 20.44 24.6 35.45 Figure 19: Combina on DMARDS used PRELIMINARY REPORT: APRIL 2009 - AUGUST 2010 National Infl ammatory Arthritis Registry NIAR 30

5.4 USE OF BIOLOGICS

The use of the TNF inhibitors comprising Infl iximab, Etanercept and Adalimumab was 3.9 in this pa ent cohort.

5.5 USE OF ORAL STEROIDS

Short courses of oral steroids is some mes used as bridging therapy. The use of steroids in this pa ent popula on was 38.2.

5.6 USE OF NSAIDSCOX2 INHIBITORS

Non steroidal an -infl ammatory drugs NSAIDS is used as analgesic therapy. If NSAIDS are contraindicated, pa ents can be prescribed cyclo-oxygenase 2 inhibitors COX2 INHIBITORS. About 62 of pa ents had been on NSAIDS COX2 INHIBITORS.

5.7 SURGERY

4 of pa ents have undergone arthroplasty. Surgical interven ons such as arthrodesis, spinal surgery and synovectomy are not commonly performed. Surgeries not directly related to rheumatoid arthri s for example appendicectomy or caesearean sec ons are categorized into other. 25 20 15 10 5 4 Arthroplasty Arthrodesis Spinal surgery Synovectomy Other 0.4 0.4 0.8 23.3 Figure 20: Surgical interven ons DISCUSSION