RHEUMATOID ARTHRITIS IN RHEUMATOLOGICAL CARE OF RUSSIA: THE SEVERITY OF THE DISEASE IN A RUSSIAN PATIENT POPULATION: A CROSS-SECTIONAL EPIDEMIOLOGICAL STUDY (RAISER)

Abstract

Objective: To study the severity of rheumatoid arthritis in a Russian patient population on the basis of the data of rheumatological care. Methods. Polyclinic and hospital rheumatologists from 27 cities and towns of Russia (a total of 30 centers) participated in the cross-sectional epidemiological study. The study included all patients with valid rheumatoid arthritis, who had consecutively turned to a polyclinic rheumatologist or who had been treated at hospital during the established 3-month period. The demographic and social characteristics of a patient, his/her occupation, comorbidity, the onset and duration of rheumatoid arthritis, clinicofunctional status at the study and antirheumatic therapy were recorded. Results. A total of 1504 patients, including 1271 women, were enrolled; their mean age at the study was 53 years; the mean duration of the disease (after the onset of its first symptoms) was 10.5 years. Most (66%) patients had a family. More than half of the examinees were professionals and specialists. More than 64% of patients were unemployed at the study. Mean disease activity scores were high: morning stiffness [Ме, range 25-75%] for mean 60.0 (30.0-180) min; number of tender (mean [SD] - 26.1±15.8), and swollen (13.4±11.4) joints; ESR, 29.45±15.5 mm/hr; pain, 58.1±22.6 mm (VAS); general health status, 57.4±20.6 mm (VAS). The mean DAS28 score (mean [SD]) was 5.44±1.18. The absolute majority (94%) of patients had erosive arthritis (Steinbrocker stages II-IV). Severe extraarticular manifestations were identified in 10%. The distribution of the patients by the ACR functional classes was as follows: Class I, 8%; Class II, 29%; Class III, 52%, and Class IV, 11%. Comorbidity was as high as 75%, there was a preponderance of cardiovascular diseases, diabetes mellitus, and chronic lung disease. The mean HAQ score in the examined patient cohort was 1.81±0.8. At the study, 89 and 43% of the patients received nonsteroidal anti-inflammatory drugs and systemic glucocorticoids, respectively. Methotrexate (62%) headed the list of basic anti-inflammatory drugs, sulfasalazine (8%), leflunomide (7%), and aminoquinolines (6%) were much less frequently used. Biologicals were given to 9% of the patients. Conclusion. The examined cohort of Russian patients with rheumatoid arthritis, which reflects experience in real clinical practice, is generally characterized by the severe course of the disease in both clinical and functional parameters.

Keywords

• rheumatoid arthritis
• functional classes