Eduard Ling1, Shachaf Ofer-Shiber2, Or Goren3, Yair Molad1. 1. Rheumatology Unit, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel. 2. Department of Internal Medicine H, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel. 3. Anesthesiology and Intensive Care Division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Abstract
BACKGROUND: Tight control of disease activity is the recommended target of therapy for rheumatoid arthritis (RA). OBJECTIVES: To determine the outcome of RA with respect to disease activity and the rate of remission, as measured by the DAS-28, in a real-world inception cohort. METHODS: We conducted an observational cross-sectional study of a single-center real-world inception cohort of 101 consecutive patients being treated for RA in 2009-2010 in a rheumatology outpatient clinic. Patients were managed at the discretion of the attending rheumatologist with the goal of achieving remission. DAS-28 scores were calculated and analyzed by clinical and treatment variables derived from the medical files. RESULTS: Mean patient age was 58.6 +/- 13.4 years and mean duration of disease 10.7 +/- 7.9years. Disease remission (DAS-28 < 2.6) was achieved in 26.7% of patients and low disease activity (> 2 .6 DAS-28 < 3.2) in 17%. Monotherapy with a conventional disease-modifying anti-rheumatic drug (C-DMARD, 21% of patients at last follow-up) was associated with a significantly lower mean DAS-28 score and C-reactive protein level than combined C-DMARD treatment (79% of patients), and with shorter disease duration than combined treatment with C-DMARDs or C-DMARD(s)+biological DMARD (40% of patients). Rheumatoid factor and anti-cyclic citrullinated peptide positivity had no effect on DAS-28 scores. Time from diagnosis was inversely correlated with DAS-28 scores. CONCLUSIONS: The achievement of low disease activity and remission in a significant portion of our inception cohort of patients with RA suggests that the treat-to-target strategy is feasible and effective in routine clinical practice.
BACKGROUND: Tight control of disease activity is the recommended target of therapy for rheumatoid arthritis (RA). OBJECTIVES: To determine the outcome of RA with respect to disease activity and the rate of remission, as measured by the DAS-28, in a real-world inception cohort. METHODS: We conducted an observational cross-sectional study of a single-center real-world inception cohort of 101 consecutive patients being treated for RA in 2009-2010 in a rheumatology outpatient clinic. Patients were managed at the discretion of the attending rheumatologist with the goal of achieving remission. DAS-28 scores were calculated and analyzed by clinical and treatment variables derived from the medical files. RESULTS: Mean patient age was 58.6 +/- 13.4 years and mean duration of disease 10.7 +/- 7.9years. Disease remission (DAS-28 < 2.6) was achieved in 26.7% of patients and low disease activity (> 2 .6 DAS-28 < 3.2) in 17%. Monotherapy with a conventional disease-modifying anti-rheumatic drug (C-DMARD, 21% of patients at last follow-up) was associated with a significantly lower mean DAS-28 score and C-reactive protein level than combined C-DMARD treatment (79% of patients), and with shorter disease duration than combined treatment with C-DMARDs or C-DMARD(s)+biological DMARD (40% of patients). Rheumatoid factor and anti-cyclic citrullinated peptide positivity had no effect on DAS-28 scores. Time from diagnosis was inversely correlated with DAS-28 scores. CONCLUSIONS: The achievement of low disease activity and remission in a significant portion of our inception cohort of patients with RA suggests that the treat-to-target strategy is feasible and effective in routine clinical practice.
Authors: Pedro Santos-Moreno; Nelson J Alvis-Zakzuk; Laura Villarreal-Peralta; Maria Carrasquilla-Sotomayor; Fernando de la Hoz-Restrepo; Nelson Alvis-Guzmán Journal: Clinicoecon Outcomes Res Date: 2021-06-23