Review of actual treatment of rheumatoid arthritis in Moldova

Abstract

Introduction: Rheumatoid Arthritis (RA) is an autoimmune disease that affects about 21 million people worldwide (0.6-1.3%). In Moldova, RA prevalence is of 1% among adult population, meaning 35000 cases. Untreated it leads to joint destruction with following deformity and disability. In the last 25 years, a better understanding of RA immunopathogenesis, along with expanding technology, has led to significant advances in drug development. Beginning with the wider use of methotrexate in rheumatology in the 1980’s, improved disease management has resulted in improved functional outcomes, decreased need for surgical intervention and growing use of disease-modifying antirheumatic drug (DMARD). The next great advance began in 1998 with the introduction of biologic agents targeting the pro-inflammatory cytokines, which have enabled the application of an ethiopathogenic therapy. Objectives and Purpose: Our study aimed the reviewing of medication evidence currently used in RA patients from Moldova and detecting the percentage of patients treated with biologies. Materials and methods: Data were extracted from 40 files of RA patients treated in the Rheumatology unit of the Clinical Hospital “Sfinta Treime”, Chisinau city in the period January-July 2011. Results: From 40 files of RA patients, 6 (15%) were men and 34 (85%) were women (male to female ratio 1:5). The mean age was 52.85 years, ranging from 20 to 75 years; 82.5% of patients were aged 45-70 years. Disease duration ranged from 1 to 25 years, with a mean of 8.22 years. 82.5% of patients had seropositive RA; 35% had chronic and 60% progressive disease, while 5% patients had early arthritis. 77.5% of cases had grade III disease activity and 67.5% had grade III functional impairment. 100% of patients administered NSAIDs (diclofenac, nimesulide); various SAIDs (prednisolon, methylprednisolon, dexamethasone) are used in proportion of 92.5% from total number. As to DMARD therapy - 77.5% patients administered methotrexate (7.5-10mg weekly); 20% of patients use either used sulfasalazine (l-2g/24h) in the past and 5% use leflunomide 20mg. 1 (2,5%) patient administered rituximab and 5 (12.5%) - tocilizumab. Conclusions: The main DMARD therapy was the internationally accepted gold standard, methotrexate, while a significant number of patients used sulfasalazine and 5% presently use leflunomide (the second largely accepted DMARD for the treatment of Rheumatoid Arthritis). Although the majority of the patients had severe disease, biological agents were used in small proportions, only 1 patient administered rituximab (anti CD20 therapy) and 5 (12.5%) - tocilizumab (IL6 inhibitor). The main limitation to this restricted use is the cost of the therapy, i.e the yearly cost of methotrexate for the insured patient is of 1200 MDL, leflunomide therapy costs around 20000 MDL, sulfasalazine is 100% covered by the insurance, while rituximab costs 104000 MDL and tocilizumab therapy varies 96-192000 MDL per 1 course.