title: Monitoring patients with rheumatoid arthritis in routine care: experiences from a treat-to-target strategy using the DANBIO registry.
abstract: OBJECTIVE
  Advances in aggressive use of conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) as well as biological DMARDs (bDMARDs) have improved the treatment armamentarium for rheumatologists, and modern treatment principles include a treat-to-target (T2T) strategy. However, little is known about the feasibility of a T2T strategy in patients with rheumatoid arthritis (RA) treated in routine care. The aim of the present study was to (i) present the annual number of patients included in DANBIO between 2006 and 2013 and their disease characteristics and (ii) estimate coverage of DANBIO by 2013.
  
  
  METHODS
  Patients who were registered with RA for the first time in the nationwide Danish DANBIO database between year 2006 and 2013 were included. Baseline characteristics were assessed in patients treated with bDMARDs and csDMARDs, respectively. The fraction of patients with low/moderate/high disease activity (i.e. DAS28 (CRP-based, 4 variables) was calculated for each calendar year.
  
  
  RESULTS
  From 2006-2013 the number of patients increased from 2,395 to 14,249. By 2013, 29.8% of patients were receiving bDMARD. Patients in the csDMARD group were older, had shorter disease duration, lower disease activity, less disability and radiographic damage. By 2013, 19% of csDMARD (15% of bDMARD) patients were in ACR/Boolean remission. Coverage had increased to between 41% and 79% for patients with RA, for the bDMARD group it was 94%.
  
  
  CONCLUSIONS
  Systematic monitoring of RA patients with real-time feedback to the physician is feasible, although the goal of treat-to-target is not achieved in a substantial proportion of patients in routine care.
authors.affiliation: DANBIO, Center for Rheumatology and Spine Diseases, Glostrup Hospital, Glostrup, Denmark. merete.hetland@dadlnet.dk.
authors.forename: M L
authors.initials: ML
authors.lastname: Hetland
authors.forename: D V
authors.initials: DV
authors.lastname: Jensen
authors.forename: N S
authors.initials: NS
authors.lastname: Krogh
mesh_terms: D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000188:drug therapy*; D003718:Denmark; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011237:Predictive Value of Tests; D012042:Registries / Q000592:standards*; D012074:Remission Induction; D012720:Severity of Illness Index; D059039:Standard of Care; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents