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 has become recognized as a standard of good practice embodying the principle that rapid attainment of remission, or low disease activity, can halt joint damage and maintain good quality of life.
Objectives The aim of this study was to describe global change in Disease Activity Score 28 (DAS28) using T2T strategy for a 60 month period in a large cohort of patients from a Colombian specialized in RA center.
Methods A descriptive cohort study was conducted. Medical records of patients from specialized in RA center were reviewed; those patients were followed-up under T2T standards and a multidisciplinary approach. Each patient had a minimum of 6 follow-up visits. Clinical follow-up was designed by the authors 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 activity disease was analyzed using Pearson's statistics.
Results 3618 patients meet the inclusion criteria. 72% were receiving conventional DMARDs therapy and 28% were receiving biological therapy. 83% were woman and 17% were men. Mean age was 61 years ±11. Mean DAS28 at beginning was 3.3±1.3 and at the end of five year period was 2.8±0.7. The difference of medians for DAS28 at begging and at the end showed improvement with statistical significance (p<0.00). It was found a global increase in the percentage of patients in remission and LDA and decrease in moderate and severe disease activity groups (from 31% to 19% and from 12% to 2% respectively) with statistical significance.
Conclusions This study show evidence of an improvement in DAS28 and level of disease activity in a cohort of RA patients from a specialized center in Colombia treated under recommendations of T2T strategy; it was found a global increase in the percentage of patients in remission (REM) and decrease in moderate and severe disease activity groups. This revision shows the importance of T2T follow-up and a multidisciplinary treatment for the management or RA.
Disclosure of Interest None declared