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 2 years 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 A T2T strategy during a 24 month period in a large cohort of RA patients treated with conventional DMARDs.
Methods A descriptive cross-sectional study was performed. Patients from a 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 using DAS28: every 3-5 weeks (DAS28 >5.1), every 7-9 weeks (DAS28 ≥3.2 and ≤5.1), and every 11-13 weeks (DAS28 <3.2). In case of DAS28 >3.2 it was mandatory to introduce adjustments in treatment based on a predetermined clinical guideline. We calculated percentages and averages from this data and divided patients in four groups: remission (Rem), low disease activity (LDA), moderate disease activity (MDA) and severe disease activity (SDA). Global change in DAS28 was determined at beginning, 6, 12, and 24 months an assessed using Chi-square test.
Results 705 patients were included in this study, 560 (79.3%) women and 145 (20.5%) men. All patients had established disease (more than 2 years of duration) and average age 60.1 y/o. Regarding the entire cohort, majority of patients were using DMARDs alone or in combination 450 (63.8)% of patients were using methotrexate, 481 (68.22%) leflunomide, 176 (24.9%) sulfasalazine, and prednisolone 126 (17.8%). The difference of medians for each variable showed improvement with statistical significance (p<0.00).
Conclusions This study shows general improvement of DAS28 in RA patients treated with conventional DMARDs applying a T2T strategy; it was found a globally increase in the percentage of patients in remission group and decrease in MDA/SDA groups. 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, and was proved that achieving remission/LDA using only conventional DMARDs is a realistic goal in clinical practice.
Disclosure of Interest None declared