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Despite Recommendations, Treatment Not Always Escalated Amid RA Activity

Despite Recommendations, Treatment Not Always Escalated Amid RA Activity

Tue, 02/11/2020 - 17:36

Even with moderate-to-high rheumatoid arthritis (RA) disease activity, the frequency of treatment change in patients is relatively low, according to a study published in Arthritis Care & Research.


Recommendations call for the routine measurement of RA disease activity and associated treatment changes in patients to attain low disease activity or remission, researchers explained. They conducted their study in part to see how common treatment escalation per treat-to-target principles actually was implemented.


The analysis included data for 27,274 adults with RA from the American College of Rheumatology’s national Rheumatology Informatics System for Effectiveness (RISE) registry from January 2016 through June 2017.

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The most common tools clinicians used to measure patients’ disease activity were the RAPID3 (Routine Assessment of Patient Index Data 3), which was used for nearly 79% of patients, and the Clinical Disease Activity Index (CDAI), which was used for 34% of patients.


Over 12 months of follow-up, one-third to two-thirds of patients failed to change their treatment, according to the study, even when RAPID3 or CDAI scores indicated moderate or high disease activity.


Patients aged 75 years and older, as well as patients already receiving combination therapy with conventional synthetic or biological disease-modifying antirheumatic drugs (DMARDs), were less likely to change treatment, the researchers found.


“Multimodal interventions directed at both patients and providers are needed,” they wrote, “to encourage shared decision-making, goal-directed care, and to overcome barriers to treatment escalation.”


Jolynn Tumolo




Yun H, Chen L, Xie F, et al. Do patients with moderate or high disease activity escalate rheumatoid arthritis therapy according to treat-to-target principles? Results from the Rheumatology Informatics System for Effectiveness Registry of the American College of Rheumatology. Arthritis Care & Research. 2020;72(2):166-175.


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