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Barriers to optimal disease control for rheumatoid arthritis patients with moderate and high disease activity

journal contribution
posted on 2023-05-17, 21:16 authored by Tymms, K, Zochling, J, Scott, J, Bird, P, Burnet, S, De Jager, J, Griffiths, H, Nicholls, D, Roberts, L, Arnold, M, Littlejohn, G

Objective: To evaluate barriers that prevent rheumatoid arthritis (RA) patients from achieving Disease Activity Score in 28 joints using the erythrocyte sedimentation rate (DAS28-ESR) scores within the current recommended levels for low disease activity (LDA) or clinical remission (DAS28-ESR score <3.2).

Methods: Using an electronic medical record program, clinical data for RA patients treated in Optimising Patient Outcomes in Australian Rheumatology clinics, with a recorded DAS28-ESR score, were collected at one point in time. The data included demographics, medications, disease measures, and the rheumatologist's opinion of the main barriers preventing improvement to the recommended DAS28 score.

Results: Of the 4,037 patients with a recorded DAS28-ESR score, 304 patients (7.5%) had high disease activity (HDA) and 1,211 patients (30%) had moderate disease activity (MDA). For 584 HDA or MDA patients, the barriers to disease control (BTCs) were recorded by the rheumatologist when there was no adjustment to disease-modifying antirheumatic drug (DMARD) therapy. The recorded BTCs were irreversible joint damage (19.7%), patient-driven preference (14.7%), noninflammatory musculoskeletal pain (9.2%), insufficient time to assess the effect of recently initiated DMARDs (9.2%), safety concerns (7.5%), comorbidities (6.5%), resistant disease (6.3%), and other less common reasons. These patients received DMARDs (97.4%), including biologic agents (34.1%), methotrexate (74.8%), and oral corticosteroids (41.8%).

Conclusion: This study identified clinical situations in which rheumatologists elected to continue RA patients with MDA or HDA on DMARD therapy without adjustment to achieve clinical remission or an LDA target of a DAS28-ESR score <3.2.

History

Publication title

Arthritis Care and Research

Volume

66

Pagination

190-196

ISSN

2151-464X

Department/School

Menzies Institute for Medical Research

Publisher

Jossey Bass, Ed. & Pub.

Place of publication

United States

Rights statement

Copyright 2014 American College of Rheumatology

Repository Status

  • Restricted

Socio-economic Objectives

Clinical health not elsewhere classified

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