Clinical Inertia in Response to ACR Recommendations for RA Treatment?

Publication of the American College of Rheumatology recommendations for treating patients who have rheumatoid arthritis (RA) with biologic and nonbiologic disease-modifying antirheumatic drugs (DMARDs) had a minimal effect on prescribing practices. Most patients with low disease activity received care consistent with the recommendations, but most with more active and aggressive disease did not.

Harrold and associates identified biologics-naive patients with RA who visited a rheumatologist before and at least 6 months after the recommendations were published and divided them into methotrexate (MTX) monotherapy and multiple nonbiologic DMARD cohorts. Initiation or dose escalation of biologic and nonbiologic DMARDs in response to active disease was assessed.

After 1 visit, 24% to 37% of patients who received MTX mono­therapy and had moderate disease activity and a poor prognosis or high disease activity received care consistent with the recommendations; after 2 visits, 34% to 56% of the MTX monotherapy group received such care. In patients who received multiple nonbiologic DMARDs, 31% to 47% and 43% to 51% of those with moderate or high disease activity received care consistent with the recommendations after 1 visit and 2 visits, respectively.

The authors noted that improving quality of care will require addressing the issue of clinical inertia.