title: Patient perspectives on achieving treat-to-target goals: a critical examination of patient-reported outcomes.
abstract: OBJECTIVE
  Treat-to-target (T2T) recommendations suggest that rheumatoid arthritis (RA) patients should strive for remission or low disease activity (LDA). However, it is unclear whether patients experiencing a good response to biologic agents might experience further improvement in patient-reported outcomes (PROs) if they subsequently achieve a lower disease activity state, particularly the T2T goals of LDA or remission.
  
  
  METHODS
  Using the Consortium of Rheumatology Researchers of North America database, we identified RA patients initiating biologic agents. We restricted the analysis to patients with improvement (Clinical Disease Activity Index [CDAI] improvement of ≥10 units) at 3-6 months (baseline visit; n = 1,368) with a followup visit approximately 9 months later (n = 984). Patients in CDAI remission or with a worsened disease activity category were excluded, leaving 562 eligible patients. PROs (global assessment, pain, and fatigue by 0-10 visual analog scales and disability by the modified Health Assessment Questionnaire [M-HAQ]) were examined at these 2 visits. Mean change in PROs compared achievement of a lower disease activity category versus staying in the same disease activity category, adjusting for potential confounders.
  
  
  RESULTS
  Patients who achieved a lower disease activity category (40% of the eligible cohort, 86% of these achieving LDA or remission) had significantly better improvement in patient pain (-14.9; 95% confidence interval [95% CI] -18.4, -11.6), patient global (-17.5; 95% CI -20.8, -14.3), fatigue (-8.5; 95% CI -15.8, -1.3), and M-HAQ score (-0.13; 95% CI -0.18, -0.08) compared to patients who stayed in the same disease activity category. However, even for patients improving, fewer than half exceeded the minimum clinically important difference for each PRO.
  
  
  CONCLUSIONS
  Achievement of a lower disease activity disease state, especially T2T goals, was associated with further improvement in PROs, albeit modest in magnitude.
authors.affiliation: University of Alabama at, Birmingham.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Curtis
authors.forename: Ying
authors.initials: Y
authors.lastname: Shan
authors.forename: Leslie
authors.initials: L
authors.lastname: Harrold
authors.forename: Jie
authors.initials: J
authors.lastname: Zhang
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Greenberg
authors.forename: George W
authors.initials: GW
authors.lastname: Reed
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D001688:Biological Products / Q000627:therapeutic use*; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016018:Least-Squares Analysis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010147:Pain Measurement; D010361:Patients / Q000523:psychology*; D010465:Perception; D011237:Predictive Value of Tests; D012074:Remission Induction; D057566:Self Report; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products