Characterizing RA Treatment Patterns

We extracted the following information from the VA databases: rehabilitation visits (physical and occupational therapy), rheumatology visits, plain radiographs (hand, wrist, foot, ankle and cervical spine), extra-articular manifestations (pulmonary, soft tissue nodules, Felty's syndrome and Sjogren's syndrome), number of inflammatory marker (CRP and ESR) tests, number of platelet counts and chemistry panels ordered, rheumatoid factor testing, joint surgery (hand, wrist, knee, foot, ankle, elbow, cervical spine and shoulder) and DMARD use. The administrative study data period included both the one-year (1 July 1999 to 29 June 2000) and two-year (1 July 1 1998 to 29 June 2000) period before the one-year chart review study period.
Each physical therapy and occupational therapy visit was counted as a rehabilitation visit. Tests for CRP and ESR were aggregated into one category. Tests performed on the same day counted as separate tests. The number of hand, wrist, foot, ankle and cervical spine radiographs were also added together into one category. Three methods were used to count the number of prescriptions in a given year. First, we counted the total number of prescriptions (including repeat prescriptions) for the following 10 medications: auranofin, aurothioglucose, azathioprine, cyclosporine, etanercept (Enbrel, Amgen), hydroxychloroquine, infliximab (Remicade, Centocor), leflunomide, methotrexate and sulfasalazine (adalimumab, abatacept and rituximab were not yet available for RA). For the second method, prescriptions for each DMARD were counted once and added to obtain the total number of different DMARDs. For the third method, synthetic DMARDs and biological DMARDs were counted separately. Prescription for each type of DMARD was counted only once and then added together to obtain the total number of different synthetic DMARDs and biological DMARDs.