Clinical characteristics and patient-reported outcomes in patients with inadequately controlled rheumatoid arthritis despite ongoing treatment

Taylor, Peter; Alten, Rieke; Gómez-Reino, Juan J.; Caporali, Roberto; Bertin, Philippe; Sullivan, Emma; Wood, Robert; Piercy, James; Vasilescu, Radu; Spurden, Dean; Alvir, José; Tarallo, M.

doi:10.1136/rmdopen-2017-000615

Cited by 23 publications

(15 citation statements)

References 38 publications

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“…Observational data have previously suggested a substantial “evidence to practice gap”, i.e., in the institution of T2T, with the prevalence of inadequate disease control reported in a significant proportion of RA patients [10,11,12]. A recent systematic report on real-world remission rates under treat-to-target strategy shows an improvement over recent years, although sustained remission is still regarded as rare [13].…”

Section: Management Of Ra May Be Suboptimalmentioning

confidence: 99%

Physician Adherence to Treat-to-Target and Practice Guidelines in Rheumatoid Arthritis

Batko

Krzanowski

et al. 2019

JCM

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Principles of treat-to-target (T2T) have been widely adopted in both multinational and regional guidelines for rheumatoid arthritis (RA). Several questionnaire studies among physicians and real-world data have suggested that an evidence–practice gap exists in RA management. Investigating physician adherence to T2T, which requires a process measure, is difficult. Different practice patterns among physicians are observed, while adherence to protocolized treatment declines over time. Rheumatologist awareness, agreement, and claims of adherence to T2T guidelines are not always consistent with medical records. Comorbidities, a difficult disease course, communication barriers, and individual preferences may hinder an intensive, proactive treatment stance. Interpreting deviations from protocolized treatment/T2T guidelines requires sufficient clinical context, though higher adherence seems to improve clinical outcomes. Nonmedical constraints in routine care may consist of barriers in healthcare structure and socioeconomic factors. Therefore, strategies to improve the institution of T2T should be tailored to local healthcare. Educational interventions to improve T2T adherence among physicians may show a moderate, although beneficial effect. Meanwhile, a proportion of patients with inadequately controlled RA exists, while management decisions may not be in accordance with T2T. Physicians tend to be aware of current guidelines, but their institution in routine practice seems challenging, which warrants attention and further study.

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Section: Management Of Ra May Be Suboptimalmentioning

confidence: 99%

Physician Adherence to Treat-to-Target and Practice Guidelines in Rheumatoid Arthritis

Batko

Krzanowski

et al. 2019

JCM

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“…This becomes even more difficult in light of the fact that many studies used inappropriate Nevertheless, despite the wide array of therapeutic options currently available for treating RA, some patients continue to report unmet clinical needs, including ongoing pain, impaired physical/mental function and fatigue [39]. This observation can be seen in…”

Section: Accepted Manuscriptmentioning

confidence: 99%

The Mediterranean diet, fish oil supplements and Rheumatoid arthritis outcomes: evidence from clinical trials

Petersson

Philippou

Rodomar

et al. 2018

Autoimmunity Reviews

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The impact of dietary interventions such as specific types of diet or nutritional supplements in rheumatoid arthritis (RA) has been subject to increased attention in recent years. The recognition of the unmet need to better understand the effects of specific dietary interventions on disease outcomes in RA, along with the growing patient interest on lifestyle interventions beyond pharmacotherapy, have informed the undertaking of this narrative literature review. The benefits of the Mediterranean Diet (MD) have been shown in various studies, although only a limited number of trials focus specifically on RA. Based on the studies reviewed, the MD may provide benefits in reducing pain and swollen and tender joints in RA patients. There is more and better evidence that n-3 polyunsaturated fat (PUFA) supplementation has the potential to reduce inflammation and provide clinical benefit, possibly slowing progression to pharmacotherapy. Yet, many of these studies to date are limited in their methodology; this being partly a reflection of the complexity of the research questions being addressed. Consequently, the conclusions that can be robustly drawn from their results are restricted. With a focus on clinical trials on the MD and fish oil supplementation, this review critically appraises the evidence, discussing the findings of studies in the wider context of impact on RA outcomes, methodological challenges, and practical points to consider as part of the routine care of RA patients.

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“…However, potential reasons include physician and/or patient dissatisfaction with therapeutic targets that concentrate solely on the attainment of disease activity states as recently published. 25 Clinical time constraints precluding the ability to book frequent patient follow-ups that assess components of composite DASs can also contribute.…”

Section: Discussionmentioning

confidence: 99%

Factors influencing use of biologic therapy and adoption of treat-to-target recommendations in current European rheumatology practice

Taylor¹,

Alten²,

Gómez-Reino³

et al. 2018

PPA

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ObjectiveThe aim of this study was to identify factors that influence treatment adjustments and adoption of a treat-to-target (T2T) strategy in patients with rheumatoid arthritis (RA) in European practices.MethodsCross-sectional data were drawn from the Adelphi 2014 RA Disease Specific Programme. Treatment patterns and clinical characteristics were investigated in patients treated with biologic disease-modifying antirheumatic drugs (bDMARDs) vs non-bDMARDs. For the T2T analysis, patients were subdivided into two subsets (RA diagnosis <2 or ≥2 years) and compared according to the approach used (no target = no T2T approach; pragmatic = target different from remission; and aspirational = target set as remission).ResultsData from 2,536 patients were analyzed (mean age: 52.76 years and mean time since RA diagnosis: 6.05 years). Of the 1,438 patients eligible to receive bDMARDs, 55% did not receive them. Initiation of bDMARDs in a bDMARD-naïve patient was prompted by worsening of the disease. In the RA diagnosis <2 years subset, a T2T approach was not adopted in 58% of the patients, whereas 8% and 34% adopted a pragmatic and aspirational approach, respectively. In the RA diagnosis ≥2 years subset, 45%, 19%, and 36% of the patients adopted a no target, pragmatic, and aspirational approach, respectively. Physician satisfaction with RA control was lower in the RA diagnosis <2 years subset than in the RA diagnosis ≥2 years subset (65% vs 77% satisfied, respectively; P<0.0001).ConclusionThis analysis shows that the use of bDMARDs remains suboptimal and that a T2T strategy is not universally adopted.

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Clinical characteristics and patient-reported outcomes in patients with inadequately controlled rheumatoid arthritis despite ongoing treatment

Cited by 23 publications

References 38 publications

Physician Adherence to Treat-to-Target and Practice Guidelines in Rheumatoid Arthritis

Physician Adherence to Treat-to-Target and Practice Guidelines in Rheumatoid Arthritis

The Mediterranean diet, fish oil supplements and Rheumatoid arthritis outcomes: evidence from clinical trials

Factors influencing use of biologic therapy and adoption of treat-to-target recommendations in current European rheumatology practice

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