Treatment Management of

Rheumatoid
Arthritis

Findings and In Depth

Analysis

Findings and In Depth

Analysis

Patients load and monthly

work averages

Rheumatologists Monthly Work Load

KSA
(n=30)

Rheumatoid
Arthritis
Ankylosing
Spondylitis
Psoriatic
Arthritis
Juvenile
Rheumatoid
Arthritis
Others

Monthly Work
Load
(AV. Number of
Patients)
75

Split between
new and
Repeated
Patients

15

238

24%

76%

46%

24%

31%

78%

12

Split According to
Disease Severity
(Percentage)

15%
47%

22%

38%

74%

21%
32%

26%

47%

67%

23%
In33%KSA, Rheumatologists see an28%average of 346
Patients per month, out of which 75 are Rheumatoid
48%
Arthritis accounting for 22% of the total
, 57
repeated and 18 new cases, the split of disease
severity is 31% mild and 69% moderate to severe
cases of RA

Understanding RA
Findings and In Depth
Analysis

Rating of Importance of Criteria used to classify Disease

Severity (Analysis Used top 2Number
boxes
- KSA)
of swellingpercentages
and tender Joints
90%
80%
CRP (Cell Reactive Protein) /ESR (Erythrocyte
Sedimentation Rate) /Anti CCP (Anti Cyclic Citrullinated
peptide)

70%
60%
50%

ACR (American College of Rheumatology) Criteria

Score

40%
30%
20%
10%
0%

HAQ Scores (Health Assessment Questionnaire)

DAS (Disease activity score)

(n=30)

Impact on the patient's quality of life.

Response to current treatment

The most preferred tool used for the Disease

Evaluation (KSA)
CRP (Cell Reactive Protein)
/ESR (Erythrocyte
Sedimentation Rate) /Anti
CCP (Anti Cyclic
Citrullinated peptide)

22%

ACR criteria score is the most preferred diagnostic tool, followed by

the DAS and the blood tests respectively. These tools are described
as practical, accurate and of international use.

DAS (Disease activity score)

ACR (American College of

Rheumatology) Criteria
Score

28%

50%

Reasons for choosing each criteria as

the most suitable (KSA)
78%
Easy and practical

Accurate and Objective

Internationnally used

ACR, N=9

80%

60%

DAS, N=5
44%

20%

11%

100%

75%

CPR/ESR/ Anti CCP, N=4

Objectives in the management of RA

patients (First mentioned KSA)
Prevent Complication

6%

Stop disease activity

6%

Improving patients quality of life and reliving the pain are the main
objectives of the management of RA patients

Relief oedema and sw elling

11%

Improve Mobility

11%
17%

Induce Remission

22%

Relief pain

28%

Improve patient's quality of life

0%

5%

10%

15%

20%

25%

30%

Other mentioned objectives in the

management of RA patients (KSA)
Prevent Complication

6%

Normalize CRP and ESR

6%

Again, Improving patients quality of life and reliving the pain are the
objectives of the management of RA patients mentioned by most of
the physicians

Prevent erosion

11%

Relief oedema and swelling

11%

Improve Mobility

11%

Reduce Inflamation

11%

Prevent deformity

11%
17%

Control the disease activity

Relief pain

33%

Improve patient's quality of life

33%

0%

5%

10%

15%

20%

25%

30%

35%

40%

Factors that encourage the physicians to

prescribe biological treatment to RA patients
(KSA)
40%

33%

56% of the respondents would prescribe the biologics because of their

efficacy. 49% of the physicians use them as second or third line after failure
of the DMARDs

16%

6%

Efficacy of the biologics

Inadequate response to
DMARDs

Failure of second line

therapy

Im m ediate action

5%

5%

Stops disease activity

Efficacy sustained over a

long period of tim e

89%

Barriers holding the doctors from

prescribing biologicals to their RA patients
(KSA)
All the respondents face the problem of the cost and/or availability of the biologics when they
want to prescribe them to their RA patients

22%
11%

Cost

Side effects

Not Available

6%

6%

6%

History of T.B

Contraindications

Patient's refusal

Treatment Algorithm for the moderate to severe

Rheumatoid Arthritis
In 12% of the cases,
In 12% of the cases,
physicians could switch
physicians could switch
from one of the products,
from one of the products,
mainly from NSAIDs for
mainly from NSAIDs for
the first line to
the first line to
Hydroxychloroquine or
Hydroxychloroquine or
Steroids
Steroids

MTX or NSAID
+
HQ or Steroid

Reasons
for
Reasons
for
switching
toto
switching
another
another
medication
medication are
are inin
100%
of
the
cases
100% of the cases
the
inadequate
the
inadequate
response
response toto the
the
previous
one.
previous one.

First Line

In most of the cases,

In most of the cases,
physicians add
physicians add
Hydroxychloroquine or
Hydroxychloroquine or
Steroids
Steroids
to the products for the first
to the products for the first
line
line

MTX
+
NSAIDs

Second
SecondLine
Line
Sometimes, physicians
Sometimes, physicians
switch from the second
switch from the second
line therapy to the
line therapy to the
biologics and they use
biologics and they use
them as monotherapy in
them as monotherapy in
third line
third line

Biologics

More often, the biologics

More often, the biologics
are added to the MTX
are added to the MTX
containing regimens and
containing regimens and
they are used in
they are used in
combination in third line
combination in third line
therapy
therapy

Third
ThirdLine
Line

Biologics
+
MTX based
therapy

MTX + NSAIDs
+
HQ or Steroids
Adding
another
Adding
another
medication
isis
medication
always
always due
due toto the
the
inadequate
inadequate
response
response toto the
the
previous
one.
previous
one.
Physicians
take
Physicians
take
also
into
also
into
consideration the
consideration the
ability
ability ofof the
the
patient
to
afford
patient to afford
the
thecombination.
combination.

NSAIDs/Steroids are not used as a chronic therapy, they are stopped after stabilization of the patients' condition and they are reintroduced upon disease flares

Treatment Algorithm and

duration of therapy (KSA)
First Line

(n=30)

Second Line

Third Line

Number of
respondents

Duration of
therapy/mo
nths

Number of
respondents

Duration of
therapy/mo
nths

Number of
respondents

Duration of
therapy/mo
nths

NSAIDs

13

1-6

1-6

2-3

MTX

10

2-6

16

1 - 36

12

3 - 36

SS

3-6

2-6

HXQ

2-5

3-6

3-6

Steroids

2-5

23

3-4

Biologics

6 36

12

2 - 24

Average Lapse of Time between RA Diagnosis

and the introduction of different therapeutic
classes (KSA)
NSAIDs

Steroids

DMARDs

Biologics

Less then 6
Months

56%

49%

61%

20%

6 months to
one year

20%

23%

9%

25%

1 2 Years

10%

16%

11%

9%

2 5 years

5%

3%

10%

21%

More then 5
years

8%

9%

9%

26%

100%
Some physicians in KSA have started to prescribe biologicals as first line therapy once the
diagnosis is confirmed. Others reserve it for third line therapy.
(n=30)

Treatment guidelines followed in the

management of moderate to severe RA patients
Don't follow any guidelines
Follow guidelines
(KSA)

27%

73%

The ACR guidelines are the only treatment protocol followed by the physicians.

Referral vs. diagnosis of RA

(KSA)
Diagnosed

General practitionner

Referred

Rheumatologists

28%

3%

24%

Family Medicine

Surgeons

Specialties of the referring doctors

7%

24%

76%

Internist

Orthopedic

38%

62%

Treatment Shares and Patterns

Findings and In Depth
Analysis

(n=30)

Overall Prescription Shares of different therapeutic

classes used in the treatment of Rheumatoid
Arthritis (KSA)

Biological

DMARDs are prescribed to almost 90%Patients

with RA, followed by NSAIDs
Biologics are prescribed to 21% of the RA
patients in KSA

21%

Steroids

45%

DMARDs

87%

NSAIDs

68%

0%

20%

40%

60%

80%

100%

Split of 100 biologics prescriptions

according to the previous therapy (KSA)
Out of each 100
prescriptions
of
Biologics, 43 are given
to patients having
DMARDs + NSAIDs
(with
or
without
Steroids) and another
22% to patients having
1 DMARDs with or
without Steroids

Classes Used
before Biological

Percentage of
Patients

1 NSAIDs with or without

steroids
Combination of NSAIDs with
or without Steroids
1 DMARD with or without
Steroids
Combination of DMARDs with
or without Steroids
NSAIDs + DMARDs with or
without Steroids

12%

Others

1%

7%
15%
22%
43%

(n=30)

100%