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Clinical rheumatology · May 2018
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, L M M Steunebrink, H E Vonkeman, P M Ten Klooster, A E van der Bijl, and van de LaarM A F JMAFJArthritis Centre Twente, Department of Rheumatology, Medisch Spectrum Twente, P.O. Box 50 000, 7500, KA, Enschede, The Netherlands.Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands..
- Arthritis Centre Twente, Department of Rheumatology, Medisch Spectrum Twente, P.O. Box 50 000, 7500, KA, Enschede, The Netherlands. g.a.versteeg@utwente.nl.
- Clin. Rheumatol. 2018 May 1; 37 (5): 1189-1197.
AbstractPatients 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.
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