Treatment Guideline Adherence Betters Rheumatoid Arthritis Disease Activity

Patricia Kachur, MD

A new retrospective assessment supports guideline-directed treatment adherence for patients with high rheumatoid arthritis disease activity scores (DAS).

In a new study from Ochsner Health System investigators, presented at the Clinical Congress of Rheumatology (CCR) West 2019 annual meeting in San Diego, evidence bucked against the fairly common practice of not adhering to guidelines set by the American College of Rheumatology (ACR) for achieving low activity and/or remission in patients with rheumatoid arthritis.

The findings come 1 year after an assessment of the ACR’s RISE registry showed 36.6% to 58.4% of patients with moderate to high-disease rheumatoid arthritis did not modify their treatment over of the following year. This study also found patients who were not receiving a biologic nor targeted therapy were far more likely to switch therapies than patients on a combination regimen.

Investigators, led by Patricia Kachur, MD, of Ochsner’s Department of Rheumatology, conducted the retrospective chart review of 94 patients aged ≥21 years old with rheumatoid arthritis, encompassing 153 index encounters and high disease activity scores (DAS28). The encounters had occurred from July 2013 — December 2018, and were used to collect patient baseline DAS28 scores.

They recorded patient treatment strategy, and classified each as either consistent with guideline-directed treatment (GDT) or not. Follow-up DAS28 scores were recorded from patient follow-up visits.

Of the 153 index encounters, 84 had sufficient data for the study. Investigators reported a mean pre-intervention DAS28 score of 6.25±0.88. The baseline score among GDT patients (6.35) was not significantly different from non-GDT patients’ score (6.15; P = .30).

Following intervention, overall mean DAS28 was 5.00±1.58. Post-therapy GDT, which included 46 patients, resulted in a mean DAS28 of 4.65±1.58. Non-GDT patients (n = 39) reported a post-intervention mean DAS28 of 5.41±.149, indicating a significantly lower mean difference for patients in the GDT group (P = .026).

Kachur and colleagues noted post-treatment DAS28 scores were significantly lower for both groups, though. Limitations to the trial included its small, non-randomized structure in a single institution, as well as its lack of consideration for co-founders including gender, age, disease duration, or comorbidities.

That said, the cohort concluded patients with rheumatoid arthritis adhering to guideline-directed therapy were associated with significantly lower follow-up DAS28 scores versus patients who did not adhere.

“Given well-established evidence that uncontrolled RA reduces the ability to perform daily activities, health-related quality of life, and permanent damage, quality improvement initiatives can focus on increasing GDT adherence to improve DAS28 scores and likely other outpatient outcomes,” investigators wrote.

The study, “Treat to Target: Do Rheumatologist Adjust Therapy Based on High Disease Activity Score (DAS), and Does This Result in Improved DAS?” was presented at CCR West 2019.