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

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.

“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.