title: Barriers to optimal disease control for rheumatoid arthritis patients with moderate and high disease activity.
abstract: OBJECTIVE
  To evaluate barriers that prevent rheumatoid arthritis (RA) patients from achieving Disease Activity Score in 28 joints using the erythrocyte sedimentation rate (DAS28-ESR) scores within the current recommended levels for low disease activity (LDA) or clinical remission (DAS28-ESR score <3.2).
  
  
  METHODS
  Using an electronic medical record program, clinical data for RA patients treated in Optimising Patient Outcomes in Australian Rheumatology clinics, with a recorded DAS28-ESR score, were collected at one point in time. The data included demographics, medications, disease measures, and the rheumatologist's opinion of the main barriers preventing improvement to the recommended DAS28 score.
  
  
  RESULTS
  Of the 4,037 patients with a recorded DAS28-ESR score, 304 patients (7.5%) had high disease activity (HDA) and 1,211 patients (30%) had moderate disease activity (MDA). For 584 HDA or MDA patients, the barriers to disease control (BTCs) were recorded by the rheumatologist when there was no adjustment to disease-modifying antirheumatic drug (DMARD) therapy. The recorded BTCs were irreversible joint damage (19.7%), patient-driven preference (14.7%), noninflammatory musculoskeletal pain (9.2%), insufficient time to assess the effect of recently initiated DMARDs (9.2%), safety concerns (7.5%), comorbidities (6.5%), resistant disease (6.3%), and other less common reasons. These patients received DMARDs (97.4%), including biologic agents (34.1%), methotrexate (74.8%), and oral corticosteroids (41.8%).
  
  
  CONCLUSIONS
  This study identified clinical situations in which rheumatologists elected to continue RA patients with MDA or HDA on DMARD therapy without adjustment to achieve clinical remission or an LDA target of a DAS28-ESR score <3.2.
authors: Canberra Rheumatology, Canberra, ACT, Australia.
authors: Kathleen
authors: K
authors: Tymms
authors: Jane
authors: J
authors: Zochling
authors: James
authors: J
authors: Scott
authors: Paul
authors: P
authors: Bird
authors: Simon
authors: S
authors: Burnet
authors: Julien
authors: J
authors: de Jager
authors: Hedley
authors: H
authors: Griffiths
authors: Dave
authors: D
authors: Nicholls
authors: Lynden
authors: L
authors: Roberts
authors: Mark
authors: M
authors: Arnold
authors: Geoffrey
authors: G
authors: Littlejohn
mesh_terms: D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy*; D001315:Australia; D001799:Blood Sedimentation; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D057286:Electronic Health Records; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011237:Predictive Value of Tests; D012074:Remission Induction; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents