Background The importance of early effective therapy, implications of disease activity in progression and use of composite disease activity measures in rheumatoid arthritis (RA), led to developing of defined therapeutic targets and tools to achieve them resulting in the Treat to Target (T2T) initiative. This strategy is being used last year in Colombia in a specialized in RA center.
Objectives The aim of this study was to describe general change in Disease Activity Score 28 (DAS28) using T2T strategy for a 12 month period in a large cohort of patients from a Colombian specialized in RA center.
Methods A descriptive cross-sectional study was performed. Patients from one specialized rheumatologic center with diagnosis of RA (ACR 1987 and 2010 ACR/EULAR criteria) were assessed applying a T2T strategy. A standardized follow-up was designed by authors using DAS28: every 3-5 weeks (for DAS28 >5.1), every 7-9 weeks (DAS28 ≥3.2 and ≤5.1), and every 11-13 weeks (DAS28 <3.2). It was measured tender joint counts (TJC), swollen joint counts (SJC), DAS28 and HAQ at every visit. In case of DAS28 >3.2 it was mandatory to introduce adjustments in treatment based on a predetermined clinical guideline. Were included patients who seen at least 3 times their doctor. We calculated percentages and averages from this data and divided patients in two groups: remission-low disease activity (Rem/LDA) patients and moderate-severe disease activity (MDA/SDA) patients. Global change in DAS28, joint counts and HAQ was determined at beginning, 6 and 12 months.
Results 1511 patients were included in this study, 1190 (78.75%) women and 321 (21.25%) men. The majority (97.6%) of patients had established disease (more than 2 years of duration); 84% of patients were in conventional therapy and 16% were using biologics. During following in 9.2% of biologic users medication was stopped because adverse event or inefficacy; in 17.9% biologic was switched. As above mentioned, for analysis we divided patients in two classes: Rem/LDA patients and MDA/SDA patients. For the initial visit, we found only 38% patients in Rem-LDA activity and 62% patients in moderate-severe activity according to DAS28. At 6 and 12 months we found improvement to 56% and 71% respectively in patients of Rem/LDA group. On the other hand was observed a decrease to 44% and 29% (at 6 and 12 months correspondingly) in patients of MDA/SDA group. The difference of medians for each variable showed improvement with statistical significance (p<0.00). It was not established improvement in HAQ with statistical significance.
Conclusions This study shows general improvement of DAS28 in a cohort of RA patients from a specialized center treated under recommendations of T2T strategy; it was found a globally increase in the percentage of patients in Rem-LDA activity group and decrease in MDA/SDA group. This revision shows importance of using of T2T follow-up and treatment for this disease and was verified that achieving remission/LDA is a realistic goal in clinical practice. Obviously, standard T2T follow-up in patients with RA should be done based on: correct use of disease activity scores and visits/treatment decisions based on.
Disclosure of Interest None Declared