Background The importance of early effective therapy, implications of disease activity in progression and use of composite disease activity measures in rheumatoid arthritis (RA), led to elaborate defined therapeutic targets and tools to achieve them. As a result, the Treat to Target (T2T) initiative was developed.
Objectives The aim of this study was to analyze the results of applying T2T strategy in a large cohort of patients with RA during 30 weeks.
Methods Patients from one specialized rheumatologic center with diagnosis of RA (ACR 1987 and 2010 ACR/EULAR criteria) were assessed applying a T2T strategy. A standardized follow-up was designed by authors using DAS28: every 3-5 weeks (for DAS28 >5.1), every 7-9 weeks (DAS28 ≥3.2 and ≤5.1), and every 11-13 weeks (DAS28 <3.2). It was measured tender joint counts (TJC), swollen joint counts (SJC), DAS28 and HAQ at every visit. In case of DAS28 >3.2 it was mandatory to introduce adjustments in treatment based on a predetermined clinical guideline. Were included patients who seen at least 3 times their doctor. Outcome: disease activity (joint counts and DAS28) at baseline and six months later; also difference in functionality (HAQ). Statistical analysis: central tendency measures and dispersion measures for continuous variables. For categorical and qualitative variables were used percentages. Bivariate correlations were performed by means of continuous variables with Spearman’s correlation. For categorical variables was used Pearson’s correlation. Meancontrastwas performedthrough t-student.
Results 563 patients. 77% women and 23%men; median age 58±10 y/o. 81% of patients were using conventional DMARDs and 19% biologic agents. Medians of disease activity measures at baseline were: DAS28: 3.5±2.0, TJC: 3.5±5.2, SJC: 2.0±3.8 and HAQ 0.3±0.5; 30 weeks later DAS28 was 3.0±1.1, TJC: 2.4±3.0, SJC: 0.9±2.4 and HAQ 0.3±0.7. The difference of medians for each variable showed improvement with statistical significance (p<0.05) except for HAQ. At the beginning 37.6% of patients were in remission and 11.3% in low disease activity (LDA), 30 weeks later this percentages increased to 45.8% and 19.5% respectively (p<0.00). On the other hand, the proportion of patients in moderate (MDA) or severe (SDA) disease activity reduced (for MDA from 35.8% to 28.7% and for SDA from 14.9% to 5.6%) with statistical significance (p<0.00). Taken as a whole, It was improvement in global DAS28 from 3.6 (CI 95% 3.3-3.7) at beginning to 3.0 (CI 95% 2.9-3.1) at 30 weeks (p<0.001).
Conclusions Application of T2T was accurate to perform tight and adequate control of RA patients. There was improvement in disease activity (TJC, SJC and DAS28) and was demonstrated that achieving remission/LDA is a realistic goal in clinical practice. On the other hand standard T2T follow-up in patients with RA should be done based on: correct application of composite disease activity scores, treatment decisions and subsequent visits based on DAS28 results, and an established clinical guideline.
Disclosure of Interest None Declared
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