Background Treat to Target (T2T) strategy becomes from the need to develop therapeutic targets and tools to achieve defined outcomes in rheumatoid arthritis (RA). This strategy is being used last years in Colombia.
Objectives The aim of this study was to describe global change in Disease Activity Score 28 (DAS28) using T2T strategy for a 24-month period in patients with conventional DMARD therapy in a large cohort of patients from a Colombian specialized in RA center.
Methods A descriptive cross-sectional study was performed. Records of patients from specialized in RA center were reviewed; those patients were followed-up under T2T standards. Clinical follow-up was according to DAS28 as follows: every 3-5 weeks (DAS28 >5.1), every 7-9 weeks (DAS28 ≥3.1 and ≤5.1), and every 11-13 weeks (DAS28 <3.1). Tender joint count (TJC), swollen joint count (SJC) and DAS28 were measured on each visit. Therapy had to be adjusted with DAS28 >3.2 unless patient's conditions don't permit it; we considered this follow-up type as implementation of a T2T strategy in patients with RA. We divided patients in four groups: remission (Rem), low disease activity (LDA), moderate disease activity (MDA) and severe disease activity (SDA) patients and the aim of the study was to look at what percentage of patients who were in moderate or severe disease activity reached a low disease activity or remission. Descriptive epidemiology was done, percentages and averages were calculated; the median of each variable was analyzed using t-Student assuming normality for DAS28 distribution and the level disease activity was analyzed using Pearson's statistics.
Results 1110 patients were included in this study, 826 (74.4%) women and 284 (25.5%) men. Average age was 61 y/o (15-89) with disease duration of 11 years (0.5-47). Concerning to treatment of entire cohort 76 (6.8%) patients were using Leflunomide alone, 114 (10.2%) Metothrexate alone, 100 (9.0%) Leflunomide plus Metothrexate, 98 (8.8%) Leflunomide plus other DMARDs, 519 (46,7%) Metothrexate plus others DMARDs and 203 (16.9%) “only” DMARDs without Leflunomide or Metothrexate. At 24 months was observed an increase in percentage of patients in remission and a decrease in percentage of patients in MDA/SDA disease activity statistically significant. For entire cohort, at beginning DAS28 was 3.6 and after 24 months of follow-up DAS28 was 2.6, showed improvement (p<0.00).
Conclusions There is a global improvement of DAS28 in a cohort of RA patients receiving only conventional therapy, treated and followed under T2T strategy recommendations; this revision shows the importance of T2T follow-up and treatment for this disease.
Disclosure of Interest None declared