Published: 2020-04-23

Prescription audit of rheumatoid arthritis patients treated at primary and secondary care level, before reaching a tertiary care centre hospital in Eastern India

Dibyendu Mukherjee, Suman Nandi, Soumyabrata Roy Chaudhuri, Sucharita Patra, Mithun Roy


Background: To analyse the usage pattern of pharmacological agents in the  treatment of  rheumatoid arthritis in Eastern India at a community level before reaching a specialized rheumatology clinic.

Methods: Total 200 patients earlier diagnosed to be RA on treatment were selected and their demographic details, duration of treatment, agents prescribed, adverse drug reactions (ADRs) were analysed.

Results: At the end of the study analysis, we observed that HCQ (24.4%) and Sulphasalazine (20.9%) were the commonest disease modifying anti-rheumatoid drug (csDMARD) used, followed by Methotrexate (16.9%). Dual combination csDMARD (33.1%) was preferred. Biological therapy was a rarity (0.5%). Steroids (21.0%) and NSAIDs (22.5%) was commonly used. Complementary and Alternative Medicines (CAM) (44.0%) was used often. Polypharmacy was the trend. Not all patients diagnosed as RA met the 2010 ACR/EULAR classification criteria of RA.

Conclusions: In 15% patients, the diagnosis of RA was inappropriate according to the recent classification criteria. csDMARD was preferred either as monotherapy or combination therapy. Use of steroids and NSAID was a common practice. ADR were mild in severity.


Prescription audit, Rheumatoid arthritis

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Kay J, Upchurch KS. ACR/EULAR 2010 rheumatoid arthritis classification criteria. Rheumatology. 2012 Dec 1;51(suppl_6):vi5-9.

Khurana R, Berney SM. Clinical aspects of rheumatoid arthritis. Pathophysiol. 2005;12(3):153-65.

Wong JB, Ramey DR, Singh G. Long-term morbidity, mortality, and economics of rheumatoid arthritis. Arthritis Rheum. 2001;44(12):2746-49.

Mijiyawa M. Epidemiology and semiology of rheumatoid arthritis in Third World countries. Rev Rhum Engl Ed. 1995;62(2):121-6.

Misra DP, Agarwal V, Negi VS. Rheumatology in India: a Bird's Eye View on Organization, Epidemiology, Training Programs and Publications. J Korean Med Sci. 2016;31(7):1013-9.

Goekoop-Ruiterman YP, de Vries-Bouwstra JK, Allaart CF. Comparison of treatment strategies in early rheumatoid arthritis: a randomized trial. Ann Intern Med. 2007;146(6):406-15.

Singh JA, Furst DE, Bharat A. 2012 update of the 2008 American College of Rheumatology recommendations for the use of disease-modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis. Arthritis Care Res (Hoboken). 2012;64(5):625-39.

Hockley T, Costa-Font J, McGuire A. A Common Disease With Uncommon Treatment. European Guideline Variations and Access to Innovative Therapies for Rheumatoid Arthritis. Policy analysis centre. London School of Economics and Political Science. 2012 Jun.

Ramos-Remus C, Raut A. Complementary and alternative practices in rheumatology. Best Pract Res Clin Rheumatol. 2008;22(4):741-57.

World Health Organization Model List of Essential Medicines. Available at: https:// Accessed 29 March 2020.

Central Drug Standard Control Organisation - Suspected Adverse Drug Reaction Form. Available at: Accessed 29 March 2020.

The use of the WHO-UMC system for standardised case causality assessment. Available at: Accessed 29 March 2020

World Health Organisation. How to Investigate Drug Use in Health Facilities: Selected Health Use Indicators; 1993. Available at: Accessed 29 March 2020.

Mittal N, Mittal R, Sharma A, Jose V, Wanchu A, Singh S. Treatment failure with disease-modifying antirheumatic drugs in rheumatoid arthritis patients. Singapore Med J. 2012;53:532-6.

Guide to Good Prescribing. WHO/DAP/94.11 Distr: General Original: English. Available at: Accessed 29 March 2020.

Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham III CO, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthrit Rheumatism. 2010 Sep;62(9):2569-81.

Arnett FC, Edworthy SM, Bloch DA. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988;31(3):315-24.

Saag KG, Teng GG, Patkar NM, Anuntiyo J, Finney C, Curtis J, et al. American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis. Arthritis Rheumatism. 59(6):762-84.

Deighton C, O'Mahony R, Tosh J, Turner C, Rudolf M. Guideline Development Group. Management of rheumatoid arthritis: summary of NICE guidance. BMJ. 2009;338:b702.

Sukhpreet, Agarwal V, Tiwari P. Treatment and monitoring cost in rheumatoid arthritis: Preliminary results from an Indian Setting. Indian J Pharm Sci. 2007;69:226-31.

Shini VK, Aboobacker S, Pahuja S, Revikumar KG. Pharmacoeconomic study of DMARDs in the management of rheumatoid arthritis. Int J Pharm Sci Rev Res. 2010;5:148-54.

Choy EH, Smith C, Doré CJ, Scott DL. A meta-analysis of the efficacy and toxicity of combining disease-modifying anti-rheumatic drugs in rheumatoid arthritis based on patient withdrawal. Rheumatol (Oxford). 2005;44(11):1414-21.

Wasserman AM. Diagnosis and management of rheumatoid arthritis. Am Fam Physician. 011;84(11):1245-52.