Application of treat-to-target principles in patients with early rheumatoid arthritis in routine clinical practice in Central-EasternEurope

Abstract

Objective: Understanding the extent to which treat-to-target (T2T) recommendations are applied by rheumatologists in patients with rheumatoid arthritis (RA) may identify gaps or issues in disease management. This study evaluated application of key T2T principles in routine management of RA patients in selected Central-Eastern European countries. Methods: This prospective, single-arm, observational study was conducted in seven countries. Patients with early RA (<1 year since diagnosis) were observed for 12 months. Primary endpoint was the percentage of patients who had a treatment target set at any time between RA diagnosis and last study visit. Disease activity (Disease Activity Score 28-joint count [DAS28]), functional status (Health Assessment Questionnaire Disability Index [HAQ-DI]), target attainment, work productivity/activity impairment (Work Productivity and Activity Impairment-Specific Health Problem [WPAI–SHP] questionnaire), and work-related outcomes were also assessed. Results: At least one treatment target was set in 507 of 514 patients (98.6%). Disease activity targets were set for 507 patients (100%) and functional targets for 335 patients (66.1%). Mean number of treatment targets per patient was 4.3 (standard deviation [SD] 2.4). At last attended visit, 218 patients (43.5%) had achieved their treatment target. Proportions of patients in remission (DAS28 <2.6) or low disease activity (DAS28 <3.2) increased from baseline to last attended visit (0.8% to 54.2% and 2.7% to 78.0%, respectively). Mean HAQ-DI scores improved from 1.3 (SD 0.6) at baseline to 0.7 (SD 0.6) at last attended visit. In patients with available data, all WPAI–SHP parameters improved from baseline to last attended visit. Outcomes for presenteeism, total activity impairment, and days with impairment were significantly (p<0.05) better in patients with remission versus low disease activity. Conclusion: Treatment targets were commonly set for early RA patients in rheumatology centers in Central-Eastern Europe. Clinical, functional, and work-related outcomes improved during 1 year’s follow-up, suggesting benefit from a T2T approach.