Challenges in Applying Treat to Target Strategy in Sample of Iraqi Patients with Rheumatoid Arthritis

Abstract

Objective: To identify barriers and factors that might hamper RA patients from achieving clinical target.

Patients and methods: A total of 100 consecutive RA patients (95 females: 5 males) were included in this retrospective cross-sectional study. Data were collected at one point in time using questionnaire and interview. Demographic data, disease duration, functional classes, medications, and compliance assessment on the current treatments by using the Compliance Questionnaire Rheumatology (CQR19) were recorded for all patients. Achievement of clinical target was defined using the Clinical Disease Activity Index (CDAI; score ≤ 10). The main barriers preventing reaching the clinical target were reported for all the patients with moderate to high disease activity.

Results: Among 100 patients with a recorded CDAI, 58 patients (58%) had not achieved the clinical target (CDAI > 10), for whom the barriers to disease control were recorded. The recorded barriers were drug unavailability/interruption (34.5%), under-treatment (20.7%), insufficient time to assess treatment response to recently initiated DMARDs (12.1%), non- inflammatory musculoskeletal pain (10.3%), had no further drug option available (10.3%), irreversible joint damage (5.2%), and other or non- identified barriers (6.9%). All patients completed CQR-19 items and poor compliance was identified as a predictor of high disease activity (P=0.001). Disease duration had a strong effect on the likelihood of patient response (P=0.035). There was a lower response rate among current smokers (P=0.007). Additionally, functional impairment appeared to be associated with high disease activity (P=0.0001). A significantly larger portion of low disease activity patients were presently on biological treatments (P=0.037) while steroid use had been associated with high disease activity (P=0.03). Age, gender, and Body Mass Index did not predict response to treatment.

Conclusions: This study identified interruption of biologic drugs supply as a large barrier to RA treatment target. The data supported improved outcomes among patients receiving biological treatments. Additionally, certain factors were associated with high disease activity including longer disease duration, functional impairment, smoking, non-adherence, and steroid use.

Keywords: Rheumatoid arthritis; barriers; disease activity measure; disease control; treat to target.

Figure 1.

Baseline and last disease status of study patients.

Figure 2.

Analysing MHDA barriers to disease control.