title: Treating rheumatoid arthritis to target: a Canadian patient survey.
abstract: BACKGROUND
  Recently, many countries, including Canada, evaluated rheumatologists' acceptance and agreement with a set of 10 Treat to Target (T2T) recommendations for rheumatoid arthritis (RA), developed by an international task force. In this study, the Canadian T2T steering committee evaluated how Canadian patients with RA perceive these recommendations.
  
  
  OBJECTIVE
  The objectives of this study were to assess the current state of RA management in Canada from a patient perspective and to assess whether and to what extent Canadians with RA agree with each of the 10 T2T recommendations and to compare the results with a previous survey completed by physicians.
  
  
  METHODS
  Participating rheumatologists were asked to invite consecutive RA patients to complete a 20-question survey. The survey was designed to assess relevant sociodemographic variables, the current treatment, and the approach to RA management as seen from the patient's perspective, as well as their agreement with the T2T recommendations.
  
  
  RESULTS
  A total of 959 patients (77% were female) were recruited by 22 participating rheumatologists from 6 Canadian provinces. Patients had a mean age of 59.1 years and mean disease duration of 12.9 years. Approximately 72% of patients were on methotrexate (76.1% combination therapy), and 36.7% were treated with biologics (6.4% monotherapy, 30.3% combination therapy). The agreement with T2T recommendations ranged from 8.6 for recommendation 4 (frequency of adjustment of drug therapy) to 9.5 for recommendation 8 (maintenance of treatment targets). These results are comparable to a previous physicians' survey except that there was more acceptance on the part of patients for more frequent visits (recommendation 5; patient agreement score was 9.06 vs physician agreement score of 6.92) and evaluations for adjustments of therapy (recommendation 6 patient agreement score was 9.39 vs physician agreement score of 7.49) to achieve the stated goal.
  
  
  CONCLUSIONS
  The results of this survey showed that Canadian patients are being treated for their RA according to the published treatment recommendations with combination disease-modifying antirheumatic drugs and biologics and a small percentage with oral corticosteroids. The majority of patients seems to be satisfied with their management and is in agreement with the T2T recommendations, although they tended to place greater emphasis than did physicians on flexibility of visit frequency and detailed assessments.
authors.affiliation: From the *Université de Montréal, Montréal, Québec; †Rheumatology Health Team - Hamilton St Joseph's Healthcare, McMaster University, Hamilton, Ontario; ‡Southlake Regional Health Centre, Newmarket, Ontario; §University of British Columbia and ∥Vancouver Arthritis Centre, Vancouver, British Columbia; and ¶Arthritis Alliance of Canada, Toronto, Ontario, Canada.
authors.forename: Boulos
authors.initials: B
authors.lastname: Haraoui
authors.forename: William
authors.initials: W
authors.lastname: Bensen
authors.forename: Carter
authors.initials: C
authors.lastname: Thorne
authors.forename: John
authors.initials: J
authors.lastname: Wade
authors.forename: Melissa
authors.initials: M
authors.lastname: Deamude
authors.forename: Jane
authors.initials: J
authors.lastname: Prince
authors.forename: Jean
authors.initials: J
authors.lastname: Légaré
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001688:Biological Products / Q000627:therapeutic use; D002170:Canada; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D017060:Patient Satisfaction; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products; D008727:Methotrexate