Health care drop-out occurs in nearly one-fourth of patients with recent onset rheumatoid arthritis

Liz Meszaros, MDLinx | August 04, 2017

Patient factors that may predict health care drop-out (HDO) in patients with recent onset rheumatoid arthritis (RA) can include failure to control disease activity, intensive treatment, and poor persistence with therapy, according to results of a study conducted in a real clinical setting of an early arthritis clinic, which were published in the journal BMC Musculoskeletal Disorders.


Health care drop-out

Researchers identified several factors predictive of drop-out in patients with recent onset rheumatoid arthritis.

“RA patients who eventually dropped out of treatment and out of the health care system had potentially disastrous consequences for their health-related quality-of-life outcomes,” wrote authors Irazú Contreras-Yáñez and Virginia Pascual-Ramos, department of immunology and rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico. “In 2004, we established an early arthritis clinic (EAC) in a referral center for rheumatic diseases in México City, México, with the aim of identifying patients with recent-onset RA. Once enrolled in the inception cohort, patients underwent evaluations scheduled at regular intervals and were prescribed treatment, according to a ‘treat to target’ strategy.”

Contreras-Yáñez and Pascual-Ramos reviewed charts from patients with recent onset RA who were attending this early arthritis clinic from February 2003 to December 2015. They defined health care drop-out (HDO) as patients who did not return for a scheduled visit for at least 1 year, and persistence with therapy as the length of time patients complied with RA treatment. Using a case-control nested within a cohort design, they compared baseline and cumulative variables between HDO cases and patients who were compliant with their scheduled visits.

In all, they analyzed data from 170 patients (mean age: 38.2 years; 89.4% female) having 1 year or more of follow-up. After a median follow-up of 86.6 months, they found that 20.6% of patients were HDO after 41.1 months.

Predictors of HDO included the cumulative number of flares, number of disease-modifying anti-rheumatic drugs per patient, and persistence of greater than 50%. After a drop out time of 3.8 years, five patients returned, and had higher disability and poorer function compared with paired controls. Outcomes were sustained up to their last follow-up.

“In conclusion, 20.6% of RA patients attending a real-life EAC setting dropped out of health care over a 10-year follow-up period. Disease activity, intensive treatment, and insufficient compliance with therapy accumulated during patient follow-up predicted HDO. Abandonment of health care had a negative impact on patient outcomes and was sustained even after health care was reinitiated,” concluded Contreras-Yáñez and Pascual-Ramos.