IMPROVING PATIENT OUTCOME IN RA WITH EARLY ANTIRHEUMATIC DRUG THERAPY

为类风湿性关节炎(RA)设计替代治疗策略 以取代传统的治疗金字塔策略最近 被提出并被普遍使用，即使他们的证据 缺乏实效性。类风湿关节炎最关键的临床问题， 因此，这些新的策略是否在 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用独特的 包含多学科数据的Aramis数据集，包括 残疾、疼痛和患者全球评估结果可在一些 超过15年的数据集。该项目将解决 问题：1)早期和一贯的调理疾病是否具有抗风湿作用 使用药物(DMARD)比使用非类固醇消炎药更有效 以非甾体抗炎药(NSAID)为基础的治疗，如果是，效果如何？2)RA的结果是什么 随着时间的推移不断改善？3)临床疗程和治疗反应 在不同种族中相似，在DR4阳性纯合子中， 杂合子和DR4阴性患者？初步研究表明， 对前两个问题的肯定回答。对于这个项目，我们将 提高与这些问题相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)相互关联 药物使用和结果，包括残疾、疼痛、全球 评估，和X射线进展，2)时间趋势的比较 药物使用和患者结局，3)配对患者之间的比较 接收不同的处理策略，4)随机模拟 使用新的计量经济学工具变量的对照试验，5) 备选战略的决策分析模型。通过这些手段， 我们希望引导医生找到最有效的治疗方法 策略和改善类风湿关节炎患者的预后。

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.