Background/Purpose: To assess the implementation of the treat to target (T2T) concept in rheumatoid arthritis (RA) patients.

Methods: Academic rheumatology units were invited to participate in a retrospective study evaluating the implementation of the T2T concept in RA patients. The charts of consecutive RA patients attending the centers during June 2015, with 3 or more previous visits, were evaluated using a common questionnaire. Data collected included demographic parameters, alcohol consumption, smoking, concomitant diseases, age at RA onset, and the presence of rheumatoid factor (RF) and erosions. Validated disease activity scores [Disease Activity Score (DAS-28), Clinical Disease Activity Index (CDAI), Simple Disease Activity Index (SDAI), Routine Assessment of Patient Index Data (RAPID3)], RA treatment including conventional or biological DMARDS, drug dosages, side effects, and patients’ preferences were recorded. Two independent rheumatologists evaluated the data to assess the implementation of T2T concept. Statistical analysis: The associations between T2T concept implementation and categorical and continuous variables were assessed by Chi square test, t-test or Mann-Whitney test as appropriate. ANOVA or Kruskal-Wallis test was used to compare continuous variables between centers as appropriate.

Results: The seven participating centers reported 724 patients; age 62.6±13.97 years, 575 (80.4%) of them women. According to the reported data, 353 (65.4%) never smoked, 474 (73.3%) were married, 592 (86.8%) lived in cities, 191 (45.7%) had above high school education, 524 (72.4%) had comorbidities, 399 (66.4%) were RF positive and 125 (59.8%) had erosions. Four centers used more than one scoring method, DAS-28 and CDAI being the most popular. Only 276 (38.1%) of the patients had disease score results in ≥3 visits. The T2T approach was implemented in 245 (33.8%) of the 724 patients. The rate of implementation varied between centers (11.1%-87% p<0.0001), and was higher in younger patients (p=0.028), non-Jews (p=0.048), alcohol consuming (p=0.009) and RF positive patients (p=0.011). There was no correlation between the T2T implementation and gender, place of residence, education, smoking, treatment regimens, and the presence of erosions or comorbidities.

Conclusion: In our sample, the implementation of the T2T concept was limited. Further studies are needed to determine the reasons for this deviation from this desirable standard as well as its consequences.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/implementation-of-the-treat-to-target-concept-in-evaluation-of-rheumatoid-arthritis-patients/