Do Patients With Moderate or High Disease Activity Escalate Rheumatoid Arthritis Therapy According to Treat-to-Target Principles? Results From the Rheumatology Informatics System for Effectiveness Registry of the American College of Rheumatology
Do Patients With Moderate or High Disease Activity Escalate Rheumatoid Arthritis Therapy According to Treat-to-Target Principles? Results From the Rheumatology Informatics System for Effectiveness Registry of the American College of Rheumatology
复制标题
DOI：
10.1002/acr.24083
复制
发表时间：
2020-02-01
影响因子：
4.7
通讯作者：
Curtis, Jeffrey R.
中科院分区：
文献类型：
--
作者：
Yun, Huifeng;Chen, Lang;Curtis, Jeffrey R.
目的尽管强烈建议常规测量类风湿关节炎（RA）疾病活动度和相关治疗变化以达到缓解/低疾病活动度，但临床医生用于评估RA患者疾病活动度和治疗变化频率的测量工具尚未得到很好的表征。因此，我们评估了医生用于评估RA疾病活动和相关RA治疗变化的不同测量工具。方法使用来自2016年1月至2017年6月的流变学信息学有效性系统（RISE）注册的数据，并使用以下标准：年龄>= 18岁，诊断为RA（国际疾病分类，第九版和第十版，代码），2016年≥ 2次RISE访视，≥ 1次RA疾病活动性测量评分，我们将符合条件的患者在首次访视时的药物使用分为单药治疗或与常规合成（cs）和生物疾病缓解抗风湿药物（bDMARD）联合治疗。结果包括12个月内治疗的变化。混合模型确定了与治疗变化相关的因素。结果在50，996例合格患者中，27，274例有纵向数据。最常用的指标是RAPID 3（78.9%）和临床疾病活动指数（CDAI）（34.2%）。随访期间治疗变化的频率相对较低（35.6-54.6%），即使对于根据RAPID 3或CDAI评分具有中度/高度疾病活动性的患者也是如此。老年患者（年龄>= 75岁;校正比值比[ORadj] 0.63 [95%置信区间（95% CI）0.50-0.78]）和已接受csDMARD联合治疗的患者（ORadj 0.45 [95% CI 0.33-0.61]）或与bDMARD联合治疗（ORadj 0.30 [95% CI 0.24-0.38]）不太可能改变RA治疗，即使在多变量调整后。结论使用美国风湿病学会的国家RISE登记处，1 - 2/3的RA患者未能改变治疗，即使在经历中度/高度疾病活动时。需要针对患者和提供者的多模式干预措施，以鼓励共同决策，目标导向的护理，并克服治疗升级的障碍。
Objective Despite strong recommendations for routine measurement of rheumatoid arthritis (RA) disease activity and associated treatment changes to attain remission/low disease activity, the measurement tools that clinicians use to evaluate RA patients' disease activity and frequency of treatment change have not been well characterized. Therefore, we evaluated different measurement tools that physicians used to assess RA disease activity and associated RA treatment changes. Methods Using data from the Rheumatology Informatics System for Effectiveness (RISE) registry from January 2016 through June 2017, and using the following criteria: age >= 18 years, diagnosis of RA (International Classification of Diseases, Ninth and Tenth Revision, codes), >= 2 RISE visits, and >= 1 RA disease activity measure scored in 2016, we classified eligible patients' drug use at the index visit as monotherapy or combination therapy with conventional synthetic (cs) and biologic disease-modifying antirheumatic drugs (bDMARDs). Outcomes include change in treatment over 12 months. Mixed models identified factors associated with treatment change. Results Among 50,996 eligible patients, 27,274 had longitudinal data. The most commonly used measures were RAPID3 (78.9%) and the Clinical Disease Activity Index (CDAI) (34.2%). The frequency of treatment change during follow-up was relatively low (35.6-54.6%), even for patients with moderate/high disease activity according to RAPID3 or CDAI scores. Older patients (age >= 75 years; adjusted odds ratio [ORadj] 0.63 [95% confidence interval (95% CI) 0.50-0.78]) and those already receiving combination therapy with csDMARDs (ORadj 0.45 [95% CI 0.33-0.61]) or combination therapy with bDMARDs (ORadj 0.30 [95% CI 0.24-0.38]) were less likely to change RA treatment even after multivariable adjustment. Conclusion Using the American College of Rheumatology's national RISE registry, one- to two-thirds of RA patients failed to change their treatment, even when experiencing moderate/high disease activity. Multimodal interventions directed at both patients and providers are needed to encourage shared decision-making, goal-directed care, and to overcome barriers to treatment escalation.