Drug consumption in the ®rst years of rheumatoid arthritis in France, the Netherlands, and Norway A longitudinal study in the early nineties Anna Ludig 1 , Francis Guillemin 1,2 , Isabelle Chary-Valckenaere 1 , Theo PBM Suurmeijer 3 , Torbjùrn Moum 4 , and Wim JA van den Heuvel 3 1 Rheumatology Unit, CHU Brabois, Nancy, 2 School of Public Health, UPRES EA 1124, University of Nancy, Nancy, France, 3 Northern Centre for Health Care Research, University of Groningen, The Netherlands, 4 Department of Behavioural Sciences in Medicine, University of Oslo, Norway Objective: To analyse drug consumption in the ®rst years of rheumatoid arthritis (RA) in France, the Netherlands, and Norway, in a longitudinal study between 1991 and 1993. Patients and Methods: The EURIDISS cohort followed up over three years included 695 RA subjects with less than 5 years disease duration. Clinical and biological parameters, drug consumption according to ATC classi®cation, and use of local treatment were recorded. Results: In the Netherlands consumption of second-line treatment occurred early on, and remained constant over time. In France, it was consumed by half of the subjects and decreased during follow-up (pv0.001). In Norway, 50% of the subjects were on second-line treatment at the outset. NSAIDs rather than corticoids were the most widely consumed. Patients underwent frequently local treatments with decrease frequency of in®ltrations over time (pv0.001). Conclusion: Second-line treatments were used in the ®rst years of disease development, following varying sequences in the different countries. Key words: rheumatoid arthritis, treatment, consumption, drugs Rheumatoid arthritis (RA) can cause severe func- tional disability in the long term despite a large range of therapeutic strategies (1 ± 3). One could wonder how far drug consumption may vary across country or practice settings. Until the 80s, therapeutic strategy in the ®rst years of RA was frequently cautious and generally followed the ``therapeutic pyramid''. Thus, at the outset, only NSAIDs were prescribed, followed two or three years later by second-line treatment which were only partially effective, and aggressive treat- ments combined with corticoids were only intro- duced at a later stage (4, 5). At the beginning of the nineties, immuno-modulators which included metho- trexate were introduced and the treatment of early RA was reviewed in the light of this development (6). There are few studies on routine therapeutic practice and at the start of the 90s there had been no comparisons in treatment strategies among Euro- pean countries (7). The doctor's prescription does not re¯ect actual treatment. None have reported on patient consumption in this period. The objective of this study is to describe the consumption of second line treatment, anti-in¯am- matory drugs, local interventions, and surgery in the ®rst years of RA and over 3 years of disease follow up from 1991 to 1993 in France, the Netherlands, and Norway, on the basis of the EURIDISS cohort (8). Materials and methods The EURIDISS longitudinal study is a population based cohort including patients recruited from a de®ned geographical area, via press campaign, hospital ®les, and ambulatory care settings, at all levels of the care system (9). The inclusion criteria were: ± patients of either sex between the ages of 20 and 70 at study outset ± patients from the following areas: Lorraine and Champagne district in France, Groningen district in the Netherlands, Oslo and Ahershus county in Norway ± patients with RA diagnosis in accordance with ARA 87 criteria (10, 11) ± disease duration under 5 years at the time of inclusion ± informed consent Exclusion criteria were: ± presence of other severe chronic disabling diseases ± association of RA with vasculitis at the time of inclusion Francis Guillemin, Ecole de Sante  Publique, Faculte  de Me Âdecine de Nancy, BP 184, FR-54 505 Vandoeuvre ± les ± Nancy, France. E-mail: francis.guillemin@sante-pub.u-nancy.fr Received 17 January 2000 Accepted 11 August 2000 Scand J Rheumatol 2000;29:352±7 352 # 2000 Taylor & Francis on license from Scandinavian Rheumatology Research Foundation