Regular Measure of Disease Activity During the Routine Care of Rheumatoid Arthritis Patients Involves Some Extra Work but Positive Results

Abstract

Background/Purpose: According to treat to target recommendations the use of validated composite measures of disease activity, which include joint assessments, is needed in routine clinical practice to guide treatment decisions with the final objective of reaching remission or low disease activity in patients with RA.Objective: to study the outcome of adding avalidated composite measure of disease activity (DAS28) to routine clinical visits. Methods: Since 2007 all RA patients (ACR-1987 criteria) in regular follow-up at the Rheumatology Service of a tertiary center change to electronic files with a DAS28-ESR calculator and this measure became mandatory in the routine care visits. Inclusion criteria: patients in regular follow-up for at least 2 years before 2007and no use of biologic agents during the study period (January 2007-December 2011). All patients could receive, free of charge, traditional DMARDs (chloroquine, methotrexate, sulfasalazine, leflunomide and azathioprine), corticosteroids (including intra-articular injections), analgesic and antiinflamatory medications as needed and according to a pre-established protocol. The first DAS28 recorded in the electronic files was compared to the last one recorded in 2011, after 4 years of regular measure of disease activity guiding therapeutic decisions (RA-study group). ERA patients (less than one year of symptoms at the beginning of treatment) submitted to a therapeutic strategy of tight control and DAS28 based clinical decisions were also evaluated. Results: a total of 304 patients was included, 217 consisting our study group(RA-SG) (86% female, mean age 63±11yrs, mean disease duration 22±10yrs) and 87 ERA patients (83% female, mean age 53±12yrs, mean disease duration 6.7±1.6yrs). ERA patients were significantly younger and with shorter disease duration. DAS28 values and different levels of disease activity are depicted below: RA-SG n217 ERA n87 2007 2011 2007 2011 DAS28 mean (SD) 3.9* (1.4) 3.3* (1.3) 3.7** (1.7) 2.9** (1.4)% DAS28 < 2.6 17* 34* 29** 45**% low disease activity 18 16 12** 24**% moderate disease activity 47 39 30** 9**% high disease activity 18 11 24 16*,** p0.05 Conclusion: regularly applying validate composite indexes such as DAS 28 leads to better control of disease activity, mainly an increased percentage of patients in DAS28 remission.