Background/Purpose: Treat to Target (T2T) strategy becomes from the need to develop therapeutic targets and tools to achieve defined outcomes in rheumatoid arthritis (RA). Moreover, models of patient-centered care where multidisciplinary teams make disease management increasingly take place in rheumatology. The aim of this study was to describe change in Disease Activity Score 28 (DAS28) using T2T strategy for a 24-month period in patients with conventional DMARD therapy in a large cohort of patients from a specialized in RA center where a model of patient-centered management is used.

Methods: A descriptive cross-sectional study was performed. Records of patients in conventional DMARD therapy from specialized in RA center were reviewed; those patients were followed-up under T2T standards. Clinical follow-up was done strictly according to DAS28 as follows: every 3-5 weeks (DAS28 > 5.1), every 7-9 weeks (DAS28 ≥ 3.1 and ≤ 5.1), and every 11-13 weeks (DAS28 < 3.1). Tender joint count (TJC), swollen joint count (SJC), DAS28 and HAQ were measured on each visit. Therapy had to be adjusted with DAS28 > 3.2 unless patient´s conditions don’t permit it; we considered this follow-up type as implementation of a T2T strategy in patients with RA. We divided patients in four groups: remission (Rem), low disease activity (LDA), moderate disease activity (MDA) and high disease activity (HDA) patients and the aim of the study was to look at what percentage of patients who were in moderate or high disease activity reached a low disease activity or remission after 24-month period. On the other hand, patients were followed-up by physiatrist, psychologist, nutritionist and therapists at least 3 times a year. Descriptive epidemiology was done, percentages and averages were calculated; the median of each variable was analyzed using t-Student assuming normality for DAS28 distribution and the level disease activity was analyzed using Pearson´s statistics. 

Results: 1110 patients were included in this study, 826 (74.4%) women and 284 (25.5%) men. Average age was 61 y/o (15-89) with disease duration of 11 years (0.5-47). Concerning to treatment of entire cohort 76 (6.8%) patients were using Leflunomide alone, 114 (10.2%) Metothrexate alone, 100 (9.0%) Leflunomide plus Metothrexate, 98 (8.8%) Leflunomide plus other DMARDs, 519 (46,7%) Metothrexate plus others DMARDs and 203 (16.9%) “only” DMARDs without Leflunomide or Metothrexate. At 24 months 66.6% of patients got remission and 13% LDA and was observed a decrease in percentage of patients in MDA/HDA statistically significant. For the entire cohort, at beginning DAS28 was 3.6 and after 24 months of follow-up DAS28 was 2.6 showing improvement (p <0.00). In overall, 98% of patients rated the quality and accessibility of multi-disciplinary care as good or excellent. 

Conclusion: There is a great improvement of DAS28 in a cohort of RA patients only receiving conventional therapy with following-up under strict T2T strategy. This is very important issue in those countries or environments with limited resources for health care. Regarding a model of patient-centered care, studies are needed to measure the impact of the multidisciplinary team on the clinical results obtained.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/improvement-of-disease-activity-and-quality-of-care-in-a-cohort-of-rheumatoid-arthritis-patients-treated-with-conventional-dmard-therapy-under-treat-to-target-recommendations-and-a-model-of-patient-ce/