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Title: Factors associated with the intensification of treatment in rheumatoid arthritis in clinical practice
Authors: Naranjo, Antonio 
Cáceres, Laura
Hernández-Beriaín, José Ángel 
Francisco, Félix
Ojeda, Soledad
Talaverano, Sigrid
Nóvoa-Medina, Javier
Martín, José Adán
Delgado, Esmeralda
Trujillo, Elisa
Álvarez, Fátima
Magdalena, Laura
Rodríguez-Lozano, Carlos
UNESCO Clasification: 32 Ciencias médicas
320509 Reumatología
Keywords: To-Target Strategy
Musculoskeletal Ultrasound
Outcomes, et al
Issue Date: 2015
Journal: Rheumatology International 
Abstract: The aim of the present study was to analyse the patterns of treatment adjustment in rheumatoid arthritis (RA) patients with active disease in routine clinical care. This was a cross-sectional study of consecutive patients with RA conducted in five hospitals. Activity scales (DAS28-ESR) and function (HAQ) were measured, as well as whether ultrasound was performed as part of the assessment. Treatment decision (no changes/reduction/intensification) and time to the next scheduled visit were the outcomes variables. Associated factors were analysed by multilevel regression models. A total of 343 patients were included (77 % women, mean age 57 years, mean RA duration 10 years), of whom 44 % were in remission by DAS28. Treatment was continued in 202 (59 %) patients, reduced in 57 (16 %), and intensified in 83 (24 %). In the 117 patients with active RA (DAS28 a parts per thousand yen 3.2), treatment was intensified in 61 (52 %). Factors associated with treatment intensification were physician and patient VAS, and DAS28, but not the centre. In the multilevel regression analysis with intensification of treatment as dependent variable, the following factors were significantly associated: DAS28 [OR 3.67 (95 % CI 2.43-5.52)], patient VAS [OR 1.04 (95 % CI 1.01-1.08)], and have performed an ultrasound [OR 3.36 (95 % CI 1.47-7.68)]. Factors associated with time to the next scheduled visit (an average of 4.3 months) were patient and physician VAS, DAS28, and centre. In clinical practice, half of the patients with active RA maintain or reduce the treatment. The decision to intensify treatment in active RA as recommended by a treat-to-target strategy is complex in practice.
ISSN: 0172-8172
DOI: 10.1007/s00296-015-3332-z
Source: Rheumatology International[ISSN 0172-8172],v. 35, p. 1851-1855
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