IMPROVING PATIENT OUTCOME IN RA WITH EARLY ANTIRHEUMATIC DRUG THERAPY

类风湿性关节炎（RA）的替代治疗策略 来取代传统的金字塔治疗策略， 被提出并被普遍使用，即使他们的证据 缺乏有效性。RA最关键的临床问题， 因此，这些新的策略是否上级旧的策略， 改善长期功能和生活质量结果。这些 重要但非常困难的问题可以通过使用 ARAMIS数据集包含多学科数据，包括 残疾、疼痛和患者总体评估结果， 超过15年的数据集。 该项目将解决 问题：1）早期和持续的疾病缓解抗风湿药 药物（DMARD）使用比非甾体抗炎药更有效 （NSAID）为基础的治疗，如果是，有多少？2)RA的结局 随着时间的推移，？3)临床病程和治疗反应 在不同的种族群体中相似，在Dr4阳性纯合子中， 杂合子和Dr4阴性患者？试点研究表明， 对前两个问题的肯定回答。对于这个项目，我们将 提高与这些问题有关的数据的质量和数量， 检查和利用新的国家初始队列患者样本，以及 采用五种互补的分析方法：1） 药物使用和结局，包括残疾、疼痛、全球 评估和X线进展，2）比较 药物使用和患者结局，3）匹配患者之间的比较 接受不同的治疗策略，4）模拟随机 使用新的计量经济学工具变量的对照试验，以及5） 替代战略的决策分析模型。通过这些手段， 我们希望指导医生找到最有效的治疗方法， 策略，并改善RA患者的预后。

Alternative management strategies for rheumatoid arthritis (RA) designed to replace the traditional therapeutic pyramid strategy have recently been proposed and are commonly used, even though evidence for their effectiveness is lacking. The most critical clinical question in RA, therefore, is whether these newer strategies are superior to the old in improving long-term functional and quality-of-life outcomes. These important but very difficult questions may be addressed uniquely using ARAMIS data sets which contain multidisciplinary data including disability, pain and patient global assessment outcomes available in some data sets extending over 15 years. This project will address the questions: 1) Is early and consistent Disease-Modifying Anti-Rheumatic Drug (DMARD) use more effective than Non-steroidal Anti-Inflammatory Drug (NSAID) based therapy and, if so, by how much? 2) Are outcomes in RA improving over time? 3) Are clinical courses and response to therapy similar in various ethnic groups, and in Dr4 positive homozygotes, heterozygotes, and Dr4 negative patients? Pilot studies have suggested positive answers to the first two questions. For this project we will improve the quality and quantity of data relevant to these questions, examine and utilize a new national inception cohort patient sample, and employ five complementary analytic approaches: 1) correlation between medication use and outcomes, including disability, pain, global assessment, and x-ray progression, 2) comparisons of temporal trends in medication use and patient outcomes, 3) comparison among matched patients receiving different treatment strategies, 4) simulation of a randomized controlled trial using new econometric instrumental variables, and 5) decision-analytic modelling of alternative strategies. By these means, we hope to guide physicians toward the most effective treatment strategies and to improve patient outcomes in RA.