Background The decision to intensify treatment when arthritis is active is more complex in practice than make management guidelines and treat to target (T2T)
Objectives To analyze the habits of intensified treatment of rheumatoid arthritis (RA) in patients with active disease in routine clinical care.
Methods Cross-sectional study conducted in five hospitals in consecutive patients with RA. Inclusion criteria were patients over 18 years treated at rheumatology clinic with a diagnosis of RA (criteria 1997 and/or 2010). In the current visit the following data were collected: parameters to calculate the DAS28-ESR, active treatments (including glucocorticoids, DMARDs and biological), performed ultrasonography, therapeutic decision in the visit and the time of the next visit. The therapeutic decision was divided into three options: 1) maintenance of treatment; 2) reduction of treatment; and 3) increased treatment. Any change of DMARD or biologic was considered increased treatment.
Results 343 patients were included, 77% female, mean age 57 years and mean duration of RA 10 years. 44% of patients were in remission by DAS28. After the current visit the same treatment was recommended in 60% of patients, was reduced in 16%, and was intensified in 24%. Of the 117 patients with active RA (DAS28≥3.2) treatment was intensified in 52%; 61% if we exclude active RA in biological therapy with no difference between hospitals. In patients with active RA and biological, treatment was intensified in 16 of 44 cases (36%). Factors associated with treatment intensification were patient and physician VAS, DAS28 and performing ultrasonography. The next visit was scheduled at an average of 4.3 months. 64% of patients with active RA had a scheduled visit between 1 and 3 months. Factors associated with the time for next visit were patient VAS, physician VAS and DAS28 in this order.
Conclusions In clinical practice half of patients with active RA the treatment is maintained or reduced. Factors associated with treatment intensification were disease activity and performing ultrasonography. The decision to intensify treatment in active RA as T2T recommend is complex in practice.
Acknowledgements This study was supported by a grant from AbbVie (ACA-SPAI-12-17). AbbVie had no role in the writing of the abstract or the decision to submit it
Disclosure of Interest None declared