Background The current paradigm of optimal clinical management of patients with rheumatoid arthritis (RA) recommends reaching a state of remission or low activity of the disease, assessed by composite indexes of activity, by means of a tight control and a dynamic adjustment of available therapeutic options, using a “treat to target” strategy.
Objectives The aim of this study is to assess the level of implementation of the “treat to target” strategy and other parameters of medical quality in clinical records (CRs) of RA patients in Spanish rheumatology departments.
Methods Adult RA patients fulfilling 2010 ACR-EULAR criteria for RA and diagnosed between January 1st, 2010 and December 31st, 2013 in Spanish rheumatology departments were included. From every centre, 19 patients were randomly chosen from a computerized anonymized list provided by every department. Independent auditors assessed the CRs, verifying the fulfilling of the quality criteria included in an assessment tool specifically developed for this project. The study was approved by the ethic committees of every participant hospital. Descriptive statistics was used for the presentation of the results.
Results A total of 856 CRs from 46 rheumatology departments were included. Patients' mean age was 54 years and 71% of patients were women. Mean duration of RA was 2 years. During the follow-up, 38% of patients reached a state of low disease activity, defined by DAS28 and/or SDAI. An explicit assessment of the disease activity as a determinant element considered to choose the therapy was recorded in 32% of the CRs. An optimal escalation of methotrexate dose was registered in 72% of the cases. Use of a composite disease activity score (DAS28, SDAI, CDAI) was reported in 61% of the cases. Disease activity monitoring every 6–8 months after reaching the therapeutic target was recorded in 73% of the cases. In 99% of the cases, the clinicians had registered patient's comorbidities and these associated conditions had been considered in planning the therapeutic approach and objective. In only 4% of the CRs, visits every 4 weeks using a composite activity score had been reported during the early stage while trying to reach remission after diagnosis. Starting a DMARD in the first two weeks after the first appointment with the rheumatologist was recorded in only 35% of the cases.
Conclusions Currently, the implementation of the “treat to target” strategy is scarcely registered in clinical records of patients diagnosed with RA in Spanish rheumatology departments. A minority of patients is treated according to the “Treat to target” recommendations.
Disclosure of Interest None declared