Background In recent years, the treatment paradigm for rheumatoid arthritis (RA) has changed significantly. Treat to Target (T2T) is a global initiative that aims to provide guidance to treat RA to specific therapeutic goals
Objectives This study aims to assess the agreement and application of the 10 T2T recommendations in Singapore practice.
Methods An online survey of rheumatologists in Singapore was conducted, asking rheumatologists to score their agreement with each recommendation on a 10-point Likert scale (1= fully disagree, 10= fully agree) and to asses the extent of application in their daily practice on a 4 point Likert scale (Always, very often, not very often, never). Those who were not applying the recommendations were asked if they were willing to change their practice, with qualitative comments captured if they were not willing to change.
Results 33 out of 41 (80.5%) rheumatologists contacted responded. Of these, 87.9% were in government or restructured hospitals and the rest in private practice. There was high agreement with the recommendations, with average agreement scores ranging from 8.30 (+/- 1.61) for recommendation #6 (composite measures of disease activity are necessary) to 9.27 (+/- 1.40) for recommendation #1 (the target of treatment is remission). A majority of rheumatologists indicated that they apply the T2T recommendations in their practice, but recommendations #5 and #6 (regarding frequency of visits and use of composite measures) had the highest number of responses indicating that they were infrequently applied (24.2% and 33.3%). There was no difference between rheumatologists in private practice or government hospitals. Lack of time and manpower, inability of the patient to relate to abstract composite scores and the fact that ultrasonography may be more useful than composite scores to assess activity were reasons given for not applying these recommendations, although most were willing to change their practice.
Conclusions Most rheumatologists in Singapore agreed with and applied the T2T recommendations, although there were specific recommendations that some rheumatologists felt were contentious. A workgroup has been formed to formulate local guidelines for the treatment of RA.
Smolen JS, Aletaha D, Bijlsma JWJ, Breedveld FC, Boumpas D, Burmester G et al. Treating rheumatoid arthritis to target: recommendations of an international task force. Annals of Rheumatic Diseases 2010; 69:631
Haraoui B, Smolen JS, Aletaha D, Breedveld FC, Burmester G, Codreanu C, Da Silva JP et al. Treating rheumatoid arthritis to target: multinational recommendations assessment questionnaire. Ann Rheum Dis 2011; 70: 1999
Disclosure of Interest None Declared