Background/Purpose: Recently, many countries, including Canada, evaluated rheumatologists’ acceptance and agreement with a set of 10 Treat to Target (T2T) recommendations for rheumatoid arthritis (RA), developed by an international task force.^1-3In this study, the Canadian T2T steering committee evaluated how Canadian patients with RA perceive these recommendations. To assess the current state of RA management in Canada from a patient perspective and to assess whether, and to what extent, Canadians with RA agree with the 10 T2T recommendations.

Methods: Participating rheumatologists were asked to invite consecutive RA patients to complete a 20-question survey. The survey was designed to assess relevant socio-demographic variables, disease duration, current approach to RA management as seen from the patient perspective, and agreement with the T2T recommendations. Each T2T recommendation was re-phrased and/or re-worded in order to be easily understood by all RA patients, regardless of their level of education.⁴

Results: A total of 959 patients (77% females) were recruited by 22 participating rheumatologists from 6 Canadian provinces.  Patients had a mean age of 59.1 yrs and a mean disease duration of 12.9 yrs. Approximately 72% of patients were on methotrexate (23.9% monotherapy, 76.1% combination therapy), 22.5% were treated with biologics (13.4% monotherapy, 86.6% combination therapy), and 17.5% were receiving corticosteroids.  The patients’ mean pain intensity over the week preceding the survey was 3.4 on a 10-point scale. The majority (88%) of patients was seen by their rheumatologist every 2-6 months; approximately 92% indicated having their joints examined and being asked about their daily activities at every visit. Over 89% of the patients rated ≥8 on a 10-point scale on the clarity of their rheumatologist’s explanation. In Canada, agreement with the T2T recommendations was higher among patients than rheumatologists: For patients, the results ranged from 8.6 for recommendation #4 (frequency of adjustment of drug therapy) to 9.5 for recommendation #7 (consideration for making clinical decisions). The average rheumatologists’ agreement scores  ranged from 6.9 for recommendation #5 (the frequency of measures of disease activity) to 9.1 for recommendation #10 (the patient needs to be involved in the decision-making process).³Among patients, agreement with recommendation #4 decreased with increasing age of the patient (from 9.1 for patients <43 yrs to 7.9 for patients >74 yrs). The agreement with recommendation #5 was significantly higher for patients in Quebec (9.4) and New Brunswick (9.3) compared to British Columbia (8.6)

Conclusion: The results of this survey shed some light on the management of RA in Canada and demonstrated a significant level of agreement with the T2T recommendations among Canadian patients. Additional efforts may be required to identify the reasons behind differences in agreement levels between patients and physicians in order to narrow certain gaps and improve RA management.

1. Smolen JS, et al. Ann Rheum Dis.2010;69(4):631-637.
2. Haraoui B, et al. Ann Rheum Dis. 2011;70(11):1999-2002.
3. Haraoui B, et al. J Rheumatol. 2012;39(5):949-953.
4. De Wit MP, et al. Ann Rheum Dis. 2011 Jun; 70(6): 891-5.

---

« Back to 2012 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/treating-rheumatoid-arthritis-to-target-a-canadian-patient-survey/