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Clinical Rheumatology

, Volume 38, Issue 2, pp 273–278 | Cite as

The incidence rate and the early management of rheumatoid arthritis in Slovenia

  • Rok Ješe
  • Katja Perdan-Pirkmajer
  • Alojzija Hočevar
  • Žiga Rotar
  • Sanja Markez
  • Milena Pavič-Nikolič
  • Matija TomšičEmail author
Original Article
Part of the following topical collections:
  1. Rheumatology in Slovenia: Clinical practice and translational research

Abstract

Epidemiological data for rheumatoid arthritis (RA) differ according to ethnicity and geographical region. Moreover, despite of clear RA management guidelines, the implementation of treat-to-target (T2T) strategy often remains incomplete. Our objectives were to determine the incidence rate of RA, the clinical characteristics, and the level of adherence to the T2T guidelines in Slovenia. We analyzed prospectively the collected data of adult patients diagnosed with RA from 2014 through 2016 at the Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia. The department provides rheumatology services to a well-defined region with a population of 704,000 adult residents. During the 3-year observation, we identified 341 incipient cases of RA (75% females, median (IQR) aged 64 (52.0–75.4) years), resulting in an annual incidence rate of 16.1 per 100,000 adults (95% CI 14.5–17.9). The incidence rate peaked in the 70–79-year age interval. The median time from the onset of symptoms suggestive of RA to rheumatology consultation was 12.9 (4.4–26.1) weeks, and the median time from referral to consultation was 1 (1–3) day. Within 12 weeks of symptom onset, 161 (47.2%) incipient RA patients were examined by a rheumatologist, and 123 (36.1%) were started on DMARD therapy. The estimated incidence rate was in line with the available epidemiological data. Our early interventional clinic enabled us to identify and manage a substantial portion of RA patients within the recommended time frame.

Keywords

Incidence Management Referral Rheumatoid arthritis 

Notes

Compliance with ethical standards

The study was approved by the Republic of Slovenia National Medical Ethics Committee.

Disclosures

None.

References

  1. 1.
    Tobon GJ, Youinou P, Saraux A (2010) The environment, geo-epidemiology, and autoimmune disease: rheumatoid arthritis. J Autoimmun 35:10–14.  https://doi.org/10.1016/j.jaut.2009.12.009 CrossRefGoogle Scholar
  2. 2.
    Zlatković-Švenda MI, Stojanović RM, Šipetić-Grujičić SB, Guillemin F (2014) Prevalence of rheumatoid arthritis in Serbia. Rheumatol Int 34:649–658.  https://doi.org/10.1007/s00296-013-2897-7 CrossRefGoogle Scholar
  3. 3.
    Alamanos Y, Voulgari PV, Drosos AA (2006) Incidence and prevalence of rheumatoid arthritis, based on the 1987 American College of Rheumatology Criteria: a systematic review. Semin Arthritis Rheum 36:182–188.  https://doi.org/10.1016/j.semarthrit.2006.08.006 CrossRefGoogle Scholar
  4. 4.
    Myasoedova E, Crowson CS, Kremers HM, Therneau TM, Gabriel SE (2010) Is the incidence of rheumatoid arthritis rising? Results from Olmsted County, Minnesota, 1955-2007. Arthritis Rheum 62:1576–1582.  https://doi.org/10.1002/art.27425 CrossRefGoogle Scholar
  5. 5.
    Abhishek A, Doherty M, Kuo C-F, et al (2017) Rheumatoid arthritis is getting less frequent—results of a nationwide population-based cohort study. Rheumatology kew468. doi: https://doi.org/10.1093/rheumatology/kew468
  6. 6.
    Avci AB, Feist E, Burmester GR (2015) Biologicals in rheumatoid arthritis: current and future. RMD Open 1:e000127CrossRefGoogle Scholar
  7. 7.
    Smolen JS, Landewé R, Bijlsma J, Burmester G, Chatzidionysiou K, Dougados M, Nam J, Ramiro S, Voshaar M, van Vollenhoven R, Aletaha D, Aringer M, Boers M, Buckley CD, Buttgereit F, Bykerk V, Cardiel M, Combe B, Cutolo M, van Eijk-Hustings Y, Emery P, Finckh A, Gabay C, Gomez-Reino J, Gossec L, Gottenberg JE, Hazes JMW, Huizinga T, Jani M, Karateev D, Kouloumas M, Kvien T, Li Z, Mariette X, McInnes I, Mysler E, Nash P, Pavelka K, Poór G, Richez C, van Riel P, Rubbert-Roth A, Saag K, da Silva J, Stamm T, Takeuchi T, Westhovens R, de Wit M, van der Heijde D (2017) EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis 76:960–977.  https://doi.org/10.1136/annrheumdis-2016-210715 CrossRefGoogle Scholar
  8. 8.
    Nell VPK, Machold KP, Eberl G, Stamm TA, Uffmann M, Smolen JS (2004) Benefit of very early referral and very early therapy with disease-modifying anti-rheumatic drugs in patients with early rheumatoid arthritis. Rheumatology 43:906–914.  https://doi.org/10.1093/rheumatology/keh199 CrossRefGoogle Scholar
  9. 9.
    Van Nies JAB, Tsonaka R, Gaujoux-Viala C et al (2015) Evaluating relationships between symptom duration and persistence of rheumatoid arthritis: does a window of opportunity exist? Results on the Leiden early arthritis clinic and ESPOIR cohorts. Ann Rheum Dis 74:806–812.  https://doi.org/10.1136/annrheumdis-2014-206047 CrossRefGoogle Scholar
  10. 10.
    Monti S, Montecucco C, Bugatti S, Caporali R (2015) Rheumatoid arthritis treatment: the earlier the better to prevent joint damage. RMD Open 1:e000057CrossRefGoogle Scholar
  11. 11.
    Wabe N, Sorich MJ, Wechalekar MD, Cleland LG, McWilliams L, Lee A, Spargo L, Metcalf RG, Hall C, Proudman SM, Wiese MD (2015) Characterising deviation from treat-to-target strategies for early rheumatoid arthritis: the first three years. Arthritis Res Ther 17:1.  https://doi.org/10.1186/s13075-015-0562-0 CrossRefGoogle Scholar
  12. 12.
    Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO III, Birnbaum NS, Burmester GR, Bykerk VP, Cohen MD, Combe B, Costenbader KH, Dougados M, Emery P, Ferraccioli G, Hazes JMW, Hobbs K, Huizinga TWJ, Kavanaugh A, Kay J, Kvien TK, Laing T, Mease P, Ménard HA, Moreland LW, Naden RL, Pincus T, Smolen JS, Stanislawska-Biernat E, Symmons D, Tak PP, Upchurch KS, Vencovský J, Wolfe F, Hawker G (2010) 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European league against rheumatism collaborative initiative. Arthritis Rheum 62:2569–2581.  https://doi.org/10.1002/art.27584 CrossRefGoogle Scholar
  13. 13.
    Rossini M, Rossi E, Bernardi D, Viapiana O, Gatti D, Idolazzi L, Caimmi C, DeRosa M, Adami S (2014) Prevalence and incidence of rheumatoid arthritis in Italy. Rheumatol Int 34:659–664.  https://doi.org/10.1007/s00296-014-2974-6 CrossRefGoogle Scholar
  14. 14.
    Eriksson JK, Neovius M, Ernestam S, Lindblad S, Simard JF, Askling J (2013) Incidence of rheumatoid arthritis in Sweden: a nationwide population-based assessment of incidence, its determinants, and treatment penetration. Arthritis Care Res 65:870–878.  https://doi.org/10.1002/acr.21900 CrossRefGoogle Scholar
  15. 15.
    Carbonell J, Cobo T, Balsa A, Descalzo MA, Carmona L, SERAP Study Group (2008) The incidence of rheumatoid arthritis in Spain: results from a nationwide primary care registry. Rheumatology 47:1088–1092.  https://doi.org/10.1093/rheumatology/ken205 CrossRefGoogle Scholar
  16. 16.
    Sokolove J, Wagner CA, Lahey LJ, Sayles H, Duryee MJ, Reimold AM, Kerr G, Robinson WH, Cannon GW, Thiele GM, Mikuls TR (2016) Increased inflammation and disease activity among current cigarette smokers with rheumatoid arthritis: a cross-sectional analysis of US veterans. Rheumatol (United Kingdom) 55:1969–1977.  https://doi.org/10.1093/rheumatology/kew285 Google Scholar
  17. 17.
    Barra L, Pope JE, Orav JE, Boire G, Haraoui B, Hitchon C, Keystone EC, Thorne JC, Tin D, Bykerk VP, and the CATCH Investigators, Ahluwalia V, Akhavan P, Arbillaga H, Baron M, Bell M, Bensen W, Boire G, Bykerk V, Cividino A, Colmegna I, Haraoui P, Hitchon C, Jamal S, Keystone E, Kinkhoff A, Kraishi M, Larche M, Lyddell C, Menard H, Mosher D, Nair B, Norris E, Penney C, Pope J, Rubin L, Shaw E, Sutton E, Thorne C, Zummer M (2014) Prognosis of seronegative patients in a large prospective cohort of patients with early inflammatory arthritis. J Rheumatol 41:2361–2369.  https://doi.org/10.3899/jrheum.140082 CrossRefGoogle Scholar
  18. 18.
    Boer AC, Boonen A, van der Helm van Mil AHM (2017) Is ACPA-positive RA still a more severe disease than ACPA-negative RA? A longitudinal cohort study in RA-patients diagnosed from 2000 onwards. Arthritis Care Res (Hoboken) 70:987–996.  https://doi.org/10.1002/acr.23497 CrossRefGoogle Scholar
  19. 19.
    Smolen JS, Aletaha D, Barton A, Burmester GR, Emery P, Firestein GS, Kavanaugh A, McInnes IB, Solomon DH, Strand V, Yamamoto K (2018) Rheumatoid arthritis. Nat Rev Dis Prim 4:18001.  https://doi.org/10.1038/nrdp.2018.1 CrossRefGoogle Scholar
  20. 20.
    Gremese E, Salaffi F, Bosello SL, Ciapetti A, Bobbio-Pallavicini F, Caporali R, Ferraccioli G (2013) Very early rheumatoid arthritis as a predictor of remission: a multicentre real life prospective study. Ann Rheum Dis 72:858–862.  https://doi.org/10.1136/annrheumdis-2012-201456 CrossRefGoogle Scholar
  21. 21.
    Raza K, Stack R, Kumar K, Filer A, Detert J, Bastian H, Burmester GR, Sidiropoulos P, Kteniadaki E, Repa A, Saxne T, Turesson C, Mann H, Vencovsky J, Catrina A, Chatzidionysiou A, Hensvold A, Rantapaa-Dahlqvist S, Binder A, Machold K, Kwiakowska B, Ciurea A, Tamborrini G, Kyburz D, Buckley CD (2011) Delays in assessment of patients with rheumatoid arthritis: variations across Europe. Ann Rheum Dis 70:1822–1825.  https://doi.org/10.1136/ard.2011.151902 CrossRefGoogle Scholar
  22. 22.
    Puchner R, Janetschko R, Kaiser W, Linkesch M, Steininger M, Tremetsberger R, Alkin A, Machold K (2016) Efficacy and outcome of rapid access rheumatology consultation: an office-based pilot cohort study. J Rheumatol 43:1130–1135.  https://doi.org/10.3899/jrheum.151210 CrossRefGoogle Scholar

Copyright information

© International League of Associations for Rheumatology (ILAR) 2018

Authors and Affiliations

  • Rok Ješe
    • 1
    • 2
  • Katja Perdan-Pirkmajer
    • 1
    • 2
  • Alojzija Hočevar
    • 1
  • Žiga Rotar
    • 1
  • Sanja Markez
    • 1
  • Milena Pavič-Nikolič
    • 1
  • Matija Tomšič
    • 1
    • 2
    Email author
  1. 1.Department of RheumatologyUniversity Medical Centre LjubljanaLjubljanaSlovenia
  2. 2.Faculty of MedicineUniversity of LjubljanaLjubljanaSlovenia

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