OBJECTIVE: Despite strong recommendations for routine measurement of rheumatoid arthritis (RA) disease activity and associated treatment changes to attain remission/low disease activity, the measurement tools that clinicians use to evaluate RA patients' disease activity and frequency of treatment change have not been well characterized. Therefore, we evaluated different measurement tools that physicians used to assess RA disease activity and associated RA treatment changes. METHODS: Using data from the Rheumatology Informatics System for Effectiveness (RISE) registry from January 2016 through June 2017, and using the following criteria: age ≥18 years, diagnosis of RA (International Classification of Diseases, Ninth and Tenth Revision, codes), ≥2 RISE visits, and ≥1 RA disease activity measure scored in 2016, we classified eligible patients' drug use at the index visit as monotherapy or combination therapy with conventional synthetic (cs) and biologic disease-modifying antirheumatic drugs (bDMARDs). Outcomes include change in treatment over 12 months. Mixed models identified factors associated with treatment change. RESULTS: Among 50,996 eligible patients, 27,274 had longitudinal data. The most commonly used measures were RAPID3 (78.9%) and the Clinical Disease Activity Index (CDAI) (34.2%). The frequency of treatment change during follow-up was relatively low (35.6-54.6%), even for patients with moderate/high disease activity according to RAPID3 or CDAI scores. Older patients (age ≥75 years; adjusted odds ratio [ORadj ] 0.63 [95% confidence interval (95% CI) 0.50-0.78]) and those already receiving combination therapy with csDMARDs (ORadj 0.45 [95% CI 0.33-0.61]) or combination therapy with bDMARDs (ORadj 0.30 [95% CI 0.24-0.38]) were less likely to change RA treatment even after multivariable adjustment. CONCLUSION: Using the American College of Rheumatology's national RISE registry, one- to two-thirds of RA patients failed to change their treatment, even when experiencing moderate/high disease activity. Multimodal interventions directed at both patients and providers are needed to encourage shared decision-making, goal-directed care, and to overcome barriers to treatment escalation.
OBJECTIVE: Despite strong recommendations for routine measurement of rheumatoid arthritis (RA) disease activity and associated treatment changes to attain remission/low disease activity, the measurement tools that clinicians use to evaluate RApatients' disease activity and frequency of treatment change have not been well characterized. Therefore, we evaluated different measurement tools that physicians used to assess RA disease activity and associated RA treatment changes. METHODS: Using data from the Rheumatology Informatics System for Effectiveness (RISE) registry from January 2016 through June 2017, and using the following criteria: age ≥18 years, diagnosis of RA (International Classification of Diseases, Ninth and Tenth Revision, codes), ≥2 RISE visits, and ≥1 RA disease activity measure scored in 2016, we classified eligible patients' drug use at the index visit as monotherapy or combination therapy with conventional synthetic (cs) and biologic disease-modifying antirheumatic drugs (bDMARDs). Outcomes include change in treatment over 12 months. Mixed models identified factors associated with treatment change. RESULTS: Among 50,996 eligible patients, 27,274 had longitudinal data. The most commonly used measures were RAPID3 (78.9%) and the Clinical Disease Activity Index (CDAI) (34.2%). The frequency of treatment change during follow-up was relatively low (35.6-54.6%), even for patients with moderate/high disease activity according to RAPID3 or CDAI scores. Older patients (age ≥75 years; adjusted odds ratio [ORadj ] 0.63 [95% confidence interval (95% CI) 0.50-0.78]) and those already receiving combination therapy with csDMARDs (ORadj 0.45 [95% CI 0.33-0.61]) or combination therapy with bDMARDs (ORadj 0.30 [95% CI 0.24-0.38]) were less likely to change RA treatment even after multivariable adjustment. CONCLUSION: Using the American College of Rheumatology's national RISE registry, one- to two-thirds of RApatients failed to change their treatment, even when experiencing moderate/high disease activity. Multimodal interventions directed at both patients and providers are needed to encourage shared decision-making, goal-directed care, and to overcome barriers to treatment escalation.
Authors: Peter C Taylor; Codrina Ancuta; Orsolya Nagy; María C de la Vega; Andrey Gordeev; Radka Janková; Umut Kalyoncu; Ivan Lagunes-Galindo; Jadranka Morović-Vergles; Mariana Peixoto G U E Silva de Souza; Bernadette Rojkovich; Prodromos Sidiropoulos; Atsushi Kawakami Journal: Patient Prefer Adherence Date: 2021-02-17 Impact factor: 2.711
Authors: Jeffrey R Curtis; Fenglong Xie; Cynthia S Crowson; Eric H Sasso; Elena Hitraya; Cheryl L Chin; Richard D Bamford; Rotem Ben-Shachar; Alexander Gutin; Darl D Flake; Brent Mabey; Jerry S Lanchbury Journal: Arthritis Res Ther Date: 2020-12-04 Impact factor: 5.156
Authors: Maria I Danila; Lang Chen; Eric M Ruderman; Justin K Owensby; Ronan O'Beirne; Joshua A Melnick; Leslie R Harrold; David Curtis; W Benjamin Nowell; Jeffrey R Curtis Journal: ACR Open Rheumatol Date: 2021-12-27
Authors: Kelly D O'Neill; Kathryne E Marks; Pamela S Sinicrope; Cynthia S Crowson; Dana Symons; Elena Myasoedova; John M Davis Journal: ACR Open Rheumatol Date: 2021-09-18
Authors: Bryant R England; Huifeng Yun; Lang Chen; Jared Vanderbleek; Kaleb Michaud; Ted R Mikuls; Jeffrey R Curtis Journal: Arthritis Care Res (Hoboken) Date: 2021-08-02 Impact factor: 5.178
Authors: Daniel H Solomon; Theodore Pincus; Nancy A Shadick; Jacklyn Stratton; Jack Ellrodt; Leah Santacroce; Jeffrey N Katz; Josef S Smolen Journal: Arthritis Care Res (Hoboken) Date: 2022-02-04 Impact factor: 5.178