Monitoring of rheumatoid arthritis disease activity in individual patients: still a hurdle when implementing the treat-to-target principle in daily clinical practice

Objectives. To investigate which rheumatoid arthritis (RA) disease activity measures are being collected in patients receiving glucocorticoids, non-biologic or biologic disease-modifying antirheumatic drugs (DMARDs) in Australian rheumatology practice. Methods. A retrospective audit of medical records was conducted from eight rheumatology practices around Australia. Each rheumatologist recruited 30 consecutive eligible patients into the review, 10 of whom must have been receiving a biological agent for rheumatoid arthritis. Disease activity measures and radiographic assessments were collected from each patient's last consultation. For biologic patients, disease activity measures were also collected from when the patient was first initiated on the biological agent. Results. At last consultation, the disease measures that were recorded most often were ESR (89.2%), haemoglobin (87.5%), and CRP (84.2%). DAS28 was infrequently recorded (16.3%). The rate of recording disease activity measures for patients receiving biologic DMARDs decreased over time (mean 27 months). Conclusion. This review has shown inconsistency of RA activity measures being recorded in Australian rheumatology clinical practice. An accurate assessment of the disease process is necessary to effectively target rheumatoid arthritis patients to treat in order to achieve optimal outcomes.

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FRI0126 Aiming for remission according to any of the rheumatoid arthritis disease activity indices is more important for physical function than the actual choice of index: a longitudinal analysis in a clinical practice setting (meteor cohort)

10.1136/annrheumdis-2017-eular.3929 ◽

2017 ◽

Author(s):

PD Carvalho ◽

R Ferreira ◽

R Landewé ◽

D Vega-Morales ◽

K Salomon-Escoto ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Clinical Practice ◽

Disease Activity ◽

Longitudinal Analysis ◽

Practice Setting ◽

Rheumatoid Arthritis Disease Activity ◽

Rheumatoid Arthritis Disease ◽

Clinical Practice Setting ◽

Actual Choice ◽

Activity Indices

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Comment on: A comparison of 3 rheumatoid arthritis disease activity indices in routine clinical practice

Indian Journal of Rheumatology ◽

10.4103/injr.injr_152_17 ◽

2018 ◽

Vol 13 (1) ◽

pp. 75

Author(s):

DurgaPrasanna Misra ◽

Vikas Agarwal

Keyword(s):

Rheumatoid Arthritis ◽

Clinical Practice ◽

Disease Activity ◽

Routine Clinical Practice ◽

Rheumatoid Arthritis Disease Activity ◽

Rheumatoid Arthritis Disease ◽

Activity Indices

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Is treat-to-target really working in rheumatoid arthritis? a longitudinal analysis of a cohort of patients treated in daily practice (RA BIODAM)

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2019-216819 ◽

2020 ◽

Vol 79 (4) ◽

pp. 453-459 ◽

Cited By ~ 11

Author(s):

Sofia Ramiro ◽

Robert BM Landewé ◽

Désirée van der Heijde ◽

Alexandre Sepriano ◽

Oliver FitzGerald ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Clinical Practice ◽

Disease Activity ◽

Disease Activity Score ◽

Activity Index ◽

Disease Activity Index ◽

Daily Clinical Practice ◽

Joint Disease ◽

Activity Score ◽

Treat To Target

ObjectivesTo investigate whether following a treat-to-target (T2T)-strategy in daily clinical practice leads to more patients with rheumatoid arthritis (RA) meeting the remission target.MethodsRA patients from 10 countries starting/changing conventional synthetic or biological disease-modifying anti-rheumatic drugs were assessed for disease activity every 3 months for 2 years (RA BIODAM (BIOmarkers of joint DAMage) cohort). Per visit was decided whether a patient was treated according to a T2T-strategy with 44-joint disease activity score (DAS44) remission (DAS44 <1.6) as the target. Sustained T2T was defined as T2T followed in ≥2 consecutive visits. The main outcome was the achievement of DAS44 remission at the subsequent 3-month visit. Other outcomes were remission according to 28-joint disease activity score-erythrocyte sedimentation rate (DAS28-ESR), Clinical Disease Activity Index (CDAI), Simplified Disease Activity Index (SDAI) and American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) Boolean definitions. The association between T2T and remission was tested in generalised estimating equations models.ResultsIn total 4356 visits of 571 patients (mean (SD) age: 56 (13) years, 78% female) were included. Appropriate application of T2T was found in 59% of the visits. T2T (vs no T2T) did not yield a higher likelihood of DAS44 remission 3 months later (OR (95% CI): 1.03 (0.92 to 1.16)), but sustained T2T resulted in an increased likelihood of achieving DAS44 remission (OR: 1.19 (1.03 to 1.39)). Similar results were seen with DAS28-ESR remission. For more stringent definitions (CDAI, SDAI and ACR/EULAR Boolean remission), T2T was consistently positively associated with remission (OR range: 1.16 to 1.29), and sustained T2T had a more pronounced effect on remission (OR range: 1.49 to 1.52).ConclusionIn daily clinical practice, the correct application of a T2T-strategy (especially sustained T2T) in patients with RA leads to higher rates of remission.

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