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

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Abstract
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 Jyväskylä, Finland and 738 consecutive patients in Nashville, TN, USA. Clinical status was assessed as Larsen radiographic scores in Jyväskylä and modified health assessment questionnaire (MHAQ) in Nashville. Results. The probability of initiating MTX within 5 yrs after presentation increased from 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 Jyväskylä was 14 yrs in 1980–84 vs 8.6 in 1985–89, 4.5 in 1990–94, 1.8 in 1995–99 and 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 90% in 2004. Over this period, substantially improved outcomes were seen, most of which antedated biological agents.