Disease activity–based management of rheumatoid arthritis in Dutch daily clinical practice has improved over the past decade
- 29 January 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in Clinical Rheumatology
- Vol. 39 (4), 1131-1139
- https://doi.org/10.1007/s10067-019-04913-7
Abstract
To re-evaluate the adherence to clinical practice guidelines recommended disease activity–based management of rheumatoid arthritis (RA) in daily clinical practice, among Dutch rheumatologists in the past decade. In 2007, disease activity was measured in only 16% of outpatient visits. All rheumatologists that participated in the 2007 study were invited to re-enter our study in 2016/2017. If necessary, data were supplemented with data from other rheumatologists. For all 26 rheumatologists who agreed to participate in our study, data were collected from 30 consecutive patients that visited the outpatient clinic. Per patient, data from four consecutive rheumatologist outpatient visits were collected. Since 2007, disease activity was measured more frequently in Dutch daily clinical practice, increasing from 16 to 79% of visits (2440/3081 visits). In addition, intensification of medication based on disease activity scores increased from 33 to 50% of visits (260/525 visits). DAS/DAS28 was the most frequently used disease activity measure (1596/2440 visits). There was a wide variation among rheumatologists in measuring disease activity and intensification of medication, 20–100% and 0–75% respectively. Over the past years, there has been a large improvement in disease activity assessment in daily clinical practice. Disease activity–based medication intensifications, also called tight control or treat to target, increased to a lesser extent. Large variation between different rheumatologists and clinics indicates that there is still room for improvement. Key Points • Following guideline dissemination disease activity is assessed more frequently (79%). • There is large variation between rheumatologists, indicating room for improvement. • Finding factors that explain variation is necessary to improve tight control in daily practice.Funding Information
- AbbVie (NA)
This publication has 22 references indexed in Scilit:
- Barriers to Optimal Disease Control for Rheumatoid Arthritis Patients With Moderate and High Disease ActivityArthritis Care & Research, 2013
- 2012 Update of the 2008 American College of Rheumatology recommendations for the use of disease‐modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritisArthritis Care & Research, 2012
- Prescribing practices in a US cohort of rheumatoid arthritis patients before and after publication of the American College of Rheumatology treatment recommendationsArthritis & Rheumatism, 2011
- Achieving tight control in rheumatoid arthritisRheumatology, 2011
- Meta-analysis of tight control strategies in rheumatoid arthritis: protocolized treatment has additional value with respect to the clinical outcomeRheumatology, 2010
- EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugsAnnals Of The Rheumatic Diseases, 2010
- DAS-driven therapy versus routine care in patients with recent-onset active rheumatoid arthritisAnnals Of The Rheumatic Diseases, 2009
- American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease‐modifying antirheumatic drugs in rheumatoid arthritisArthritis Care & Research, 2008
- Intensive treatment with methotrexate in early rheumatoid arthritis: aiming for remission. Computer Assisted Management in Early Rheumatoid Arthritis (CAMERA, an open-label strategy trial)Annals Of The Rheumatic Diseases, 2007
- Resistance of rheumatoid arthritis patients to changing therapy: Discordance between disease activity and patients' treatment choicesArthritis & Rheumatism, 2007