A retrospective study on drug utilisation pattern in management of rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by joint swelling, joint tenderness, and also the destruction of synovial joints, leading to severe disability and premature mortality. About 1% of the world population and approximately 0.75% of the adult Indian population is affected by RA.

To evaluate the drug utilization patterns in the treatment of RA in the orthopaedics department in a tertiary care hospital in Mangaluru.

A retrospective study was carried out in the orthopaedics department for six months from September 2018- march 2019. Medical records of patients diagnosed with RA during 2013-2017, who satisfy the inclusion and exclusion criteria were retrieved and reviewed. Relevant details of patient demographic profile and drug therapy details, including drug name, dose, and route of administration for each patient, were collected from the patient medical record. In addition to that, relevant data on associated comorbid conditions and associated infections with its management was recorded. The collected information was summarized using descriptive statistics.

Out of 400 medical records of patients reviewed in the study, it was found that the occurrence of RA was predominantly higher in females (79.2%) than that of males (20.8%). The age group in which the disease most commonly observed was between 50 to 69 years (Male – 55.4%, Female – 48.9%). And the majority of the patients were admitted for the duration of 1 to 7 days (69.3%). In this study, the average number of drugs per prescription was found to be 7± 2.77 SD. The majority of patients diagnosed with RA were treated with Methotrexate (52.7%) followed by Hydroxychloroquine sulphate (42.5%) and Sulfasalazine (2.8%). Among the total 400 patients with RA, 331 patients had comorbidity, out of which the most common comorbidity observed in RA patients was Anemia 100(30.21%) followed by Hypertension 70(21.14%) and Type II Diabetes Mellitus 62(18.73%). The study shows that 11 patients developed RA associated infections. Tuberculosis 6(54.5%) and Urinary tract infection 4(36.4%) were the most commonly diagnosed infections, followed by and Pneumonia (9.1%).

The use of steroids in the management of RA was less compared to DMARDs and TB was found to be the most common infection in the study population and was managed well by appropriate antibiotic therapy. Also, the study showed, Anaemia, Hypertension, and Type II Diabetes Mellitus were the most common comorbidities associated with RA. Therefore, the study provides an insight into the health care providers on the importance of rational use of drugs in the treatment of Rheumatoid arthritis.