OBJECTIVES: The biologic understanding of autoimmune disease, particularly rheumatoid arthritis (RA), has resulted in rapid changes to the list of Food and Drug Administration’s (FDA) approved biologic disease modifying anti-rheumatoid arthritis drugs (bDMARD) and their laboratory and clinical surveillance guidance. Six classes of drugs, by mechanism of action, comprise the therapeutic arsenal; with one class, tumor necrosis factor inhibitor, having options of oral, sub-cutaneous, and intravenous administration. We sought to understand how these developments are reflected in routine management of RA patients by US community rheumatologists.

METHODS: Using retrospective medical chart review, physicians abstracted data on adult RA patient treated with bDMARD between March 2018 and February 2019 including: demographics, treatment sequencing, lab testing/reporting, and assessment of disease activity measures. Patient characteristics and outcomes were summarized descriptively.

RESULTS: 64 rheumatologists identified 910 RA patients: female (75.8%), white (75.3%), commercial insurance (64.5%), with median age 49 years at diagnosis. RA patients were currently prescribed the following bDMARDs: adalimumab (23.4%), etanercept (19.2%), abatacept (17.5%), certolizumab (10.8%), tocilizumab (9.8%), infliximab (8.7%), golimumab (5.8%), and rituximab (4.8%). During current bDMARD use, proportion of biologic naïve patients ranged from 85.9% (adalimumab) to 23.6% (tocilizumab). Regarding lab testing at diagnosis: rheumatoid factor (RF) tested 99% (n= 901) with 81.5% (n=734) positive; anti-citruline protein antibody (ACPA) measured 77.6% (n=706), positive (i.e., anti-CCP2 concentration >19 AU/mL) 75.9% (536/706). Regarding surveillance during current bDMARD use, the most commonly reported disease measures were: erythrocyte sedimentation rate (93.0%), C-reactive protein (79.4%), swollen joint count-28 (62.9%), and tender join count-28 (59.2%).

CONCLUSIONS: This study provides a cross sectional view into the increasing complexity of RA management. Research is needed to identify clinical and diagnostic test Profiles that distinguish patient subgroups and inform their optimum initial and subsequent treatment and effective monitoring of disease activity.