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Abstract
Objective
The aim of this study was to examine clinical characteristics of Korean rheumatoid arthritis (RA) patients with clinically indications for TNF-α blocker, and to compare their clinical parameters with the Korean National Health Insurance reimbursement criteria.
Methods
Data were obtained from a registry of RA patients who visited rheumatology clinics of Hallym University affili-ated hospitals. Among patients who were previously prescribed DMARDs for more than three months, rheumatologists selected patients clinically indicated for TNF-a blocker. The clinical characteristics at the time TNF-α blocker use was deemed indicated were examined. Radiographic damage was quantified by Modified Sharp van der Heijde score in hand and foot simple AP radiograph.
Results
From August 2010 to January 2013, five rheumatologists in four hospitals selected 109 patients clinically indicated for TNF-α blocker. When TNF-α blocker was considered, mean DAS28 was 5.2 (range 2.1∼8.05), mean swollen joint count was 6 (range 0∼22), mean tender joint count was 10.6 (range 0∼28), mean ESR was 43.2 mm/hr (range 1∼140) and mean CRP was 2.5 mg/dL (range 0.1∼18.3). The mean total modified Sharp van der Heijde score was 32.72 (range 0∼240). Eighty one percent of subjects did not have enough active joints to satisfy the Korean National Health Insurance reimbursement standard.
References
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Table 1.
Characteristics of Korean rheumatoid arthritis patients eligible for TNF-α blocker (N=109)
Table 2.
Medications used by the study subjects of Table 1 (N=109)
Table 3.
Profiles of DAS28 in study subjects at the time clinically indicated for eligible for TNF-α blocker (N=79)
| Variable | |
|---|---|
| Current DAS28 (range) | 5.2±1.28 (2.1∼8.05) |
| SJC in 28 joint (range) | 6±5.3 (0∼22) |
| TJC in 28 joint (range) | 10.6±6.6 (0∼28) |
| Active joint count in 28 joint (range) | 5.1±5 (0∼22) |
| Active joint count in large joints∗ (range) | 1.7±1.6 (0∼7) |
| ESR (mm/hr) (range) | 43.2±29 (1∼140) |
| CRP (mg/dL) (range) | 2.5±3.2 (0.1∼18.3) |
DAS28: Disease activity score 28, SJC: swollen joint count, TJC: tender joint count, Active joint count: swollen and tender joint within one joint, large joints∗: both shoulder, hip, knee, ankle, elbow, wrist, ESR: erythrocyte sedimentation rate, CRP: C-reactive protein. Data are expressed as mean± standard deviation, unless specified otherwise.
Table 4.
The Profile of Radiographic score measured by van der Heijde's modification score within 1 year at the time clinically indicated for TNF-α blocker
Table 5.
Reasons for failing the Korean National Health Insurance reimbursement criteria at the time clinically indicated for TNF-α blocker (N=109)
| Failed criteria | Number (%) |
|---|---|
| Acute phase reactant (ESR or CRP)∗ | 27/109 (24.8) |
| Active joint count†‡ | 64/79 (81) |
| Previous treatment Hx‡ | 21/109 (19.3) |
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