Background Based on a strong evidence base that pre-determined treatment targets & tight control improve outcomes, 2010 recommendations on treating to target aim to improve rheumatoid arthritis (RA) management .
Objectives This prospective audit assess compliance with these recommendations & disease activity outcomes in a large group of UK NHS rheumatology centres. We present 6-month interim results from early centres joining the audit.
Methods Newly diagnosed patients with RA were recruited at presentation to rheumatology clinics from April 2012 for 1 year follow up from diagnosis. Data on disease history, management & outcomes are collected at each visit. Correlations between recommendation compliance & change in 6 month DAS28 score were calculated for this interim analysis.
Results By December 2013, 813 patients in 38 centres were included. 152 patients [48 (32%) male] from 19 centres had evaluable data, with both baseline & 6 month DAS28 scores available. Mean (standard deviation, SD) age at diagnosis was 59.4 (14.6) years, & mean (SD) time from onset of persistent symptoms to first clinic visit was 0.49 (1.4) years. Mean (SD) DAS28 score at baseline was 4.69 (1.63) &at 6 months 3.09 (1.43) (p<0.0001). 59 (39%) achieved DAS28<2.6 & 18 (12%) DAS28 2.6-3.2 at 6 months. Table 1 shows % compliance with the recommendations & correlation between % compliance & improvement in DAS28 score. Negative values show where compliance was related to improvement in outcome. Patients who were informed of their treatment target or who had a DAS28 score at each visit had a greater improvement in DAS28 score at 6 months than those whose management did not comply with these recommendations (correlation significance p=0.03 & p=0.02 respectively).
Conclusions 39% of patients achieved clinical remission at 6 months. Informing patients of treatment targets &formal measurement of disease activity at each visit were associated with the greatest improvement in DAS28 score. The correlations in these interim results show association between compliance with recommendations &improved RA outcomes. Not necessarily causative, these associations are signals that further work to increase compliance with treat to target recommendations may be worthwhile. This project is ongoing &further results will be presented in due course.
Smolen et al. Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis 2010;69:631–637
Acknowledgements pH Associates, Marlow, Buckinghamshire
Disclosure of Interest None declared
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