Survey of the therapeutic management of rheumatoid arthritis in France: the OPALE study.

Objectives: To describe the therapeutic practice used in 2006 by French rheumatologists and hospital staff in RA patients, and to estimate the proportion of patients currently treated with DMARDs including biologics, and to estimate the ratio of patients treated according to the SFR national recommendations.

Methods: This multicentre cross-sectional study was performed in a random sample of rheumatologists selected from a comprehensive national database and stratified by setting and region. Each rheumatologist established a registry of subsequent RA patients (first step), and filled in a detailed questionnaire for the 10 first patients from the registry (second step). At the day of inclusion, RA characteristics and DMARD treatments over the past 12 months were recorded.

Results: The majority of the RA patients were women (mean age: 58 yrs). The mean DAS 28 score was 3.6, and RA was considered as clinically and radiologically severe in almost 27.0% of the cases. In the registry part, 89.9% of RA patients were currently treated with DMARDs, and 29.3% of them received a biologic DMARD alone or in combination. In 1610 patients with detailed questionnaire record, the efficacy of the current DMARD treatment was good in almost 60% of the patients. Finally, the physician's decision was to continue the ongoing treatment in 4/5 cases.

Conclusions: In this study, RA characteristics were similar to the typical RA observed in previous studies. Biologics were major drugs in DMARD treatments with 30.1% RA patients currently treated. Modification of treatments was essentially linked to a lack of therapeutic response.