Background/Purpose: International and national bodies have given evidence-based recommendations for rheumatoid arthritis (RA) treatment. We assessed the general uptake of these recommendations by asking rheumatologists about their initial treatment preferences in case they themselves developed RA.

Methods: An online survey was disseminated to practicing rheumatologists across the continents and also made accessible on social media platforms between April and June 2016.  Survey questions included following: 1. If you fell ill with seropositive active rheumatoid arthritis, what medications would you start as the first option? 2. At 3 months: if the first option does not – work, what would you take next? 3. At 3 months: if the first option would work, but you cannot really take it for disturbing side effects, what would you take next? Response options, to select one or more, included NSAIDs, Glucocorticoids (GC), and all DMARDs. Background information included age, gender, type and country of practice, and whether the participant was involved in national or international task force of guidelines/recommendations for RA.

Results: A total of 717 rheumatologists (49% female, 50% <50 years old) participated in the survey from 46 countries on 5 continents. The first preferred medication for early active seropositive RA included: MTX monotherapy 69% (sc 36%), MTX-based combination therapy 22%, another cDMARD(s) 2.7%, and biologic agent 6.2% (Figure 1).  Furthermore, 53% would take NSAIDs and 84% GC including 6.3% im, 36% ia, 41% low dose GC, 28% medium dose GC, 1.8% high dose GC, and 16% would not take any GC. In case of inefficacy, options would be MTX monotherapy 15% (sc 78%), MTX-based combination 16%, another cDMARD(s) 8%, biologic agent 60%, and in case of side effects: MTX monotherapy 5.5% (sc 80%), MTX-based combination 4.6%, another cDMARD(s) 20%, biologic agent 70% (Figure 1). The EULAR 2016 recommendation of starting with MTX monotherapy and in case of inefficacy, switching to another cDMARD or adding a biologic was followed by 49% of respondents.  

Conclusion: To our knowledge this is the first international effort to evaluate how rheumatologists would treat themselves if they were patients with early seropositive RA. Not surprisingly, biologics are the preferred option in the majority in the case of inefficacy or intolerance to first treatment. Sc MTX administration is preferred by 36% of rheumatologists as first option, despite rarely mentioned in recommendations. This may be a reflection of positive clinical experience using sc MTX. Limitations of the survey include a relatively small number of respondents and better coverage in many countries would be preferred.   Figure 1. Preferred DMARD therapy for early active seropositive RA at the initiation, in case of inefficacy or side effects at 3 months, among 717 rheumatologists around the globe.