Ascendancy of weekly low-dose methotrexate in usual care of rheumatoid arthritis from 1980 to 2004 at two sites in Finland and the United States

Objectives. To analyse consecutive patients with RA in usual rheumatology care between 1980 and 2004 at two settings for the proportion of patients taking MTX, interval from patient presentation to MTX prescription and radiographic and functional status outcomes. Methods. Longitudinal study of all patients seen in usual care between 1980 and 2004, 1982 consecutive patients in Jyvaskyla, Finland and 738 consecutive patients in Nashville, TN, USA. Clinical status was assessed as Larsen radiographic scores in Jyvaskyla and modified health assessment questionnaire (MHAQ) in Nashville. Results. The probability of initiating MTX within 5 yrs after presentation increased from < 5% in Jyvaskyla before 1989 to > 90% in 2000-04, and from 25% in Nashville in 1980-84 to > 90% since 1995. The median interval from presentation to MTX initiation in Jyvaskyla was 14 yrs in 1980-84 vs 8.6 in 1985-89, 4.5 in 1990-94, 1.8 in 1995-99 and < 1 yr in 2000-05; in Nashville, median intervals were 8.6 yrs in 1980-84, 4.4 years in 1985-89, and < 2 months in 1990-95, 1995-2000 and 2000-05. Patient outcomes were substantially improved in both settings: in Jyvaskyla, mean 5-yr Larsen radiographic scores (0-100) were 15.7 in 1980-84 vs 4.0 in 1995-99; in Nashville, mean MHAQ scores (0-3) for physical function were 1.13 in 1980-84 vs 0.57 in 2000-04. Conclusion. Early MTX in usual clinical care of RA increased from <5% in 1980 to > 90% in 2004. Over this period, substantially improved outcomes were seen, most of which antedated biological agents.