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. 2018 May;37(5):1189-1197.
doi: 10.1007/s10067-017-3962-5. Epub 2018 Feb 1.

Long-term disease and patient-reported outcomes of a continuous treat-to-target approach in patients with early rheumatoid arthritis in daily clinical practice

G A Versteeg  1   2 , L M M Steunebrink  3   4 , H E Vonkeman  3   4 , P M Ten Klooster  4 , A E van der Bijl  5 , M A F J van de Laar  3   4
Affiliations

Long-term disease and patient-reported outcomes of a continuous treat-to-target approach in patients with early rheumatoid arthritis in daily clinical practice

G A Versteeg et al. Clin Rheumatol. 2018 May.

Abstract

Patients in real life may differ from those in clinical trials. The aim of this study is to report 5-year outcomes of a continuous treat-to-target (T2T) approach in patients with rheumatoid arthritis (RA) in daily clinical practice. In the Dutch RhEumatoid Arthritis Monitoring cohort, all patients with a clinical diagnosis of RA were treated according to a protocolled T2T strategy, aimed at 28-joint Disease Activity Score (DAS28) < 2.6. Outcomes were percentages of patients in distinct levels of disease activity, mean course of DAS28 and prevalence of sustained (drug-free) remission. Also, data on functional disability (Health Assessment Questionnaire) and health-related quality of life (Short-Form 36) were examined. Mean DAS28 improved from 4.93 (95% CI 4.81-5.05) at baseline to 2.49 (95% CI 2.35-2.63) after 12 months and remained stable thereafter. Percentages of patients at 12 months with DAS28 < 2.6 (remission), DAS28 ≥ 2.6 and ≤ 3.2 (low disease activity), DAS28 > 3.2 and ≤ 5.1 (moderate disease activity) and DAS28 > 5.1 (high disease activity) were 63, 16, 18 and 3%, respectively. Sustained remission (DAS28 < 2.6 during ≥ 6 months) was observed at least once in 84% of the patients and drug-free remission (DAS28 < 2.6 during ≥ 6 months after withdrawal of all disease-modifying anti-rheumatic drugs) in 36% of the patients. Functional disability and health-related quality of life significantly improved during the first 24 weeks. Continuous application of T2T in real-life RA patients leads to favourable disease- and patient-related outcomes.

Keywords: Daily clinical practice; Drug-free sustained remission; Implementation; Rheumatoid arthritis; Treat-to-target.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Study sample and dropout
Fig. 2
Fig. 2
Percentages of patients in different levels of disease activity over the first 5 years of follow-up. DAS-ESR, disease activity in 28 joints, calculated using the erythrocyte sedimentation rate; HDA, high disease activity; MDA, moderate disease activity; LDA, low disease activity
Fig. 3
Fig. 3
The mean of the disease activity over time. DAS28-ESR, disease activity score in 28 joints, using the erythrocyte sedimentation rate
Fig. 4
Fig. 4
Box plots of Health Assessment Questionnaire (HAQ) and Short-Form 36 Health Survey (SF-36) over 5 years of follow-up. a HAQ score, b SF-36 physical component summary (PCS) score and c SF-36 mental component summary (MCS) score over 5 years of follow-up. *p < 0.05
See this image and copyright information in PMC

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