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


Tymms, K and Zochling, J and Scott, J and Bird, P and Burnet, S and De Jager, J and Griffiths, H and Nicholls, D and Roberts, L and Arnold, M and Littlejohn, G, Barriers to optimal disease control for rheumatoid arthritis patients with moderate and high disease activity, Arthritis Care and Research, 66, (2) pp. 190-196. ISSN 2151-464X (2014) [Refereed Article]

Copyright Statement

Copyright 2014 American College of Rheumatology

DOI: doi:10.1002/acr.22108


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.

Item Details

Item Type:Refereed Article
Keywords:rheumatoid arthritis, disease activity, barriers
Research Division:Biomedical and Clinical Sciences
Research Group:Clinical sciences
Research Field:Rheumatology and arthritis
Objective Division:Health
Objective Group:Clinical health
Objective Field:Clinical health not elsewhere classified
UTAS Author:Zochling, J (Dr Jane Zochling)
ID Code:88106
Year Published:2014
Web of Science® Times Cited:54
Deposited By:Menzies Institute for Medical Research
Deposited On:2014-01-13
Last Modified:2017-11-02

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