Treat to target strategy in early rheumatoid arthritis versus routine care - A comparative clinical practice study.

OBJECTIVE: To assess the 2-year effect on disease activity and health-related quality of life (HRQoL) of implementing a clinical practice treat-to-target (T2T) strategy in patients with rheumatoid arthritis (RA). METHODS: Patients in the Norwegian Very Early Arthritis Cohort 2.0 (NOR-VEAC 2.0), included 2010-2015, were treated according to T2T principles with visits at baseline, 3, 6, 9, 12 months, then every 6 months plus monthly visits until DAS28 <2.6. These patients were compared to a pre-T2T cohort of patients included in the Norwegian Disease Modifying Anti-Rheumatic Drug (NOR-DMARD) register 2006-2009. Both groups had a clinical diagnosis of RA (≤1 year) and were DMARD naïve. Disease activity and HRQoL outcomes were analysed, and the primary outcome was SDAI remission (≤3.3) at 2years. RESULTS: The T2T cohort included 293 patients (mean (SD) age 54 (13) years, 66% females, disease duration median (25,75 perc) 98 (57,164) days) and the routine care cohort 392 patients (age 54 (13) years, 68% females, 4 (0,30) days since diagnosis). At 2years, the proportion of patients achieving SDAI remission was 46% in the T2T cohort compared to 31% in the routine care cohort. EQ-5D was similar at baseline, but differed significantly between groups at 2years (median (25,75 perc) 0.77 (0.69, 0.85) vs 0.73 (0.59, 0.80), p < 0.001). Methotrexate monotherapy was the dominant DMARD regimen used to achieve SDAI remission in both cohorts. CONCLUSION: Higher remission rates and better HRQoL were achieved in patients following a T2T strategy in clinical practice compared to routine care.

Development of a feasible and responsive ultrasound inflammation score for rheumatoid arthritis through a data-driven approach.

OBJECTIVE: To develop and validate a responsive and feasible ultrasound inflammation score for rheumatoid arthritis (RA). METHODS: We used data from cohorts of early RA (development) and established RA starting/switching biologic therapy (validation). 4 tendons and 36 joints were examined by a grey scale (GSUS) and power Doppler semiquantitative ultrasound (PDUS) scoring system (full score). Ultrasound score components were selected based on factor analyses of 3-month change in the development cohort. Responsiveness was assessed by standardised response means (SRMs). We assessed the proportion of information retained from the full score by linear regression. RESULTS: 118 patients with early and 212 patients with established RA were included. The final ultrasound score included 8 joints (metacarpophalangeal 1-2-3, proximal interphalangeal 2-3, radiocarpal, metatarsophalangeal 2-3) and 1 tendon (extensor carpi ulnaris) examined bilaterally. The 6-month SRMs for the final score were -1.24 (95% CI -1.47 to -1.02) for GSUS, and -1.09 (-1.25 to -0.92) for PDUS in early RA, with 87% of total information retained for GSUS and 90% for PDUS. The new score performed somewhat better than formerly proposed scores in the validation cohort. CONCLUSIONS: The Ultrasound in Rheumatoid Arthritis 9 joint/tendon score (USRA9) inflammation score showed good responsiveness, retained most of the information from the original full score and overall performed better than previous scores in a validation cohort. TRIAL REGISTRATION NUMBERS: NCT01205854, ACTRN12610000284066; Post-results.

Similar clinical outcomes in rheumatoid arthritis with more versus less expensive treatment strategies. Observational data from two rheumatology clinics.

OBJECTIVES: Selection of efficacious medications for rheumatoid arthritis (RA) has tremendously increased over a decade including new costly biologic agents and inexpensive conventional anti-rheumatic drugs, used in combinations for more efficacy. Treatments aim at remission or at least low disease activity. Our objective was to study whether treatment target is reached and to what cost, in patients with RA in two Nordic rheumatology clinics. METHODS: Cross sectional observational clinical data of all patients with RA seen in 2010 in two Nordic county hospital rheumatology units: Kristiansand, Norway and Jyväskylä, Finland, which both serve a population of about 275,000. Measures included patient demographic measures, clinical characteristics, disease activity, functional status, and treatments. Annual costs of medications to the society were calculated per 100 patients, using an assumption that a patient is taking current medications for one year. RESULTS: Patient populations from Kristiansand and Jyväskylä were similar according to age, gender, disease duration, and prevalence of RF and CCP. Disease activity was low and patients' functional status well reserved in both clinics. Almost twice as many patients in Kristiansand than in Jyväskylä (33% vs. 17%) used biologic agents. A combination of conventional anti-rheumatic drugs was currently used by <1% of patients in Kristiansand and by 37% of patients in Jyväskylä. Estimated annual costs of medications per 100 patients were €508,000 in Kristiansand and €280,000 in Jyväskylä. CONCLUSIONS: Treatment target of remission/low disease activity and good functional status can be reached in RA using expensive and less-expensive anti-rheumatic drugs.