From the Rheumatology Centre, St. Joseph's Health Care, London, Ontario, Canada; the Hospital for Special Surgery, New York, New York, USA; the Arthritis Centre, University of Manitoba, Winnipeg, Manitoba; the University of Toronto, Toronto; Southlake Regional Health Centre, Newmarket, Ontario; the Faculty of Medicine and Health Sciences, Division of Rheumatology, Université de Sherbrooke, Sherbrooke, Quebec; the Rheumatic Disease Unit, Institut de Rhumatologie, Montreal, Quebec; McMaster University, Hamilton, Ontario; and Western University, London, Ontario, Canada.
To determine site variation by comparing outcomes across sites in an early rheumatoid arthritis cohort.
Sites from the Canadian Early Arthritis Cohort database with at least 40 patients were studied. Comparisons were made among sites in change in 28-joint Disease Activity Score (DAS28), proportion of patients in DAS28 remission, and treatment strategies.
The study included 1138 baseline patients at 8 sites, with baseline (SD) age 52 years (16.9); 72% women; 23% erosions; 54% ever smokers; 51% rheumatoid factor-positive; 37% anticitrullinated protein antibody-positive; disease duration 187 (203) days; DAS28 4.5 (1.4). Site had an effect on outcomes when adjusting for confounders. At 6 and 12 months, sites B and H, the 2 largest sites, had the best changes in DAS28 (-1.82 and -2.09, respectively, at 6 mos, and -2.27 for both at 12 mos; p