Background/Purpose: Although the goal of rheumatoid arthritis (RA) treatment is to achieve remission or low disease activity with the treat-to-target (T2T) strategy, some patients do not achieve the goal in daily clinical practice. This study was performed to determine the reasons why these patients do not achieve the treatment goal.

Methods: A total of 504 patients with RA that were treated with the T2T strategy using electronic medical record system in 2014 – 2015 were investigated retrospectively. The patients had an average age of 63.7 years, and average disease duration of 15.9 years. A total of 144 patients were evaluated with moderate or high disease activity according to the simple disease activity index (SDAI) in 2014. After 1 year, 84 patients achieved the treatment goal, i.e., remission or low disease activity, while 60 patients still showed more than moderate disease activity and did not achieve the goal. In these patients, each item of SDAI, patient background, and treatment content were investigated.

Results:

In 2014, the patients that did not achieve the treatment goal in 2015 had significantly higher age, disease activity, tender joint count, patient global assessment, and HAQ-DI than the patients that did achieve the goal. In the patients that achieved the goal, all items of SDAI were significantly improved. In the patients that did not achieve the goal, swollen joint count and physician global assessment were significantly improved. As disease activity did not decrease, 21 patients were considered to have been treated insufficiently with the T2T strategy. Twenty-one patients had joint pain without arthritis. Eighteen patients were not treated sufficiently for complications, including six elderly patients, respiratory complications in eight patients, and others.

Conclusion:

Although the treatment goal of the T2T strategy in RA is remission or low disease activity, this goal is often not achieved in daily clinical practice. The patients that do not achieve the goal have higher disease activity or are not treated sufficiently with complications. It may be possible for these patients to achieve the goal by refining the treatment strategy or providing palliative treatment for pain. Additional T2T is necessary.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/analysis-of-rheumatoid-arthritis-patients-that-did-not-achieve-the-treatment-goal-by-the-treat-to-target-strategy-in-daily-practice/