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21st century state of rheumatoid arthritis management in the UK
Background
The rheumatoid arthritis (RA) Treat to Target (T2T) recommendations1 defined in 2010 aimed to support clinicians to achieve optimal therapeutic outcomes for their patients.
Objectives
38 hospitals prospectively audited management of newly diagnosed RA patients to determine compliance with the T2T recommendations and therapeutic outcomes achieved.
Methods
From April 2012 to September 2016 and upon diagnosis of RA, data on disease history, management and clinical outcomes were collected prospectively in a web based tool. Follow up to date provides data for up to 24 months from diagnosis (baseline).
Results
1571 patients were recruited in 38 centres, with 12 months’ follow up for 713 patients and of these 269 also had 24 months’ follow up. 1021 (65%) patients were female and 1360 (87%) had a treatment target documented at baseline (1235 [79%] disease activity score 28 (DAS28) remission and 125 [8%] low disease activity state (LDAS)). DAS28 remission is defined as DAS28 <2.6, LDAS is defined as DAS28 ≥2.6<3.2. Median baseline DAS28 scores were 4.9 and 5.3 for patients having a DAS28 remission and LDAS target, respectively. The table shows DAS28 scores at baseline, 12 and 24 months, and disease management received for the subset of patients with available DAS28 scores at the relevant time points, stratified by those who did/did not achieve their remission target and those with/without sustained remission at 24 months. Of the 108 patients eligible to receive biologic therapy, according to NICE guidance, 39 (36%) received a biologic within their first 24 months of treatment.
Conclusions
The results suggest that more patients with a target set at baseline are in remission at 12 months and at 24 months than those without a target set. Number of visits, number of DAS28 scores and starting dual therapy within 6 months do not appear to affect the proportion of patients in remission at 12 months, but active management in the first 12 months (>4 visits, >4 DAS28 scores) does appear to be associated with more patients in remission at 24 months. Thus we conclude that treating RA early and aggressively, in line with the T2T guidelines, leads to sustained clinical improvement.
Authors
Ai Lyn Tan, Maya Buch, David O’Reilly, Tom Sheeran, Georgina Nock, Sarang Chitale, Paul Emery
Journal
Rheumatology
Therapeutic Area
Rheumatology
Center of Excellence
Real-world Evidence & Data Analytics
Year
2017
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