title: Effects of Achieving Target Measures in Rheumatoid Arthritis on Functional Status, Quality of Life, and Resource Utilization: Analysis of Clinical Practice Data.
abstract: OBJECTIVE
  To evaluate associations between achieving guideline-recommended targets of disease activity, defined by the Disease Activity Score in 28 joints using C-reactive protein level (DAS28-CRP) <2.6, the Simplified Disease Activity Index (SDAI) ≤3.3, or the Clinical Disease Activity Index (CDAI) ≤2.8, and other health outcomes in a longitudinal observational study.
  
  
  METHODS
  Other defined thresholds included low disease activity (LDA), moderate (MDA), or severe disease activity (SDA). To control for intraclass correlation and estimate effects of independent variables on outcomes of the modified Health Assessment Questionnaire (M-HAQ), the EuroQol 5-domain (EQ-5D; a quality-of-life measure), hospitalization, and durable medical equipment (DME) use, we employed mixed models for continuous outcomes and generalized estimating equations for binary outcomes.
  
  
  RESULTS
  Among 1,297 subjects, achievement (versus nonachievement) of recommended disease targets was associated with enhanced physical functioning and lower health resource utilization. After controlling for baseline covariates, achievement of disease targets (versus LDA) was associated with significantly enhanced physical functioning based on SDAI ≤3.3 (ΔM-HAQ -0.047; P = 0.0100) and CDAI ≤2.8 (-0.073; P = 0.0003) but not DAS28-CRP <2.6 (-0.022; P = 0.1735). Target attainment was associated with significantly improved EQ-5D (0.022-0.096; P < 0.0030 versus LDA, MDA, or SDA). Patients achieving guideline-recommended disease targets were 36-45% less likely to be hospitalized (P < 0.0500) and 23-45% less likely to utilize DME (P < 0.0100).
  
  
  CONCLUSIONS
  Attaining recommended target disease-activity measures was associated with enhanced physical functioning and health-related quality of life. Some health outcomes were similar in subjects attaining guideline targets versus LDA. Achieving LDA is a worthy clinical objective in some patients.
authors.affiliation: Bristol-Myers Squibb, Princeton, New Jersey.
authors.forename: Evo
authors.initials: E
authors.lastname: Alemao
authors.affiliation: Bristol-Myers Squibb, Hopewell, New Jersey.
authors.forename: Seongjung
authors.initials: S
authors.lastname: Joo
authors.affiliation: Bristol-Myers Squibb, Hopewell, New Jersey.
authors.forename: Hugh
authors.initials: H
authors.lastname: Kawabata
authors.affiliation: Institute of Health Policy and Management and Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands.
authors.forename: Maiwenn J
authors.initials: MJ
authors.lastname: Al
authors.affiliation: University of Pennsylvania, Philadelphia.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Allison
authors.affiliation: Institute of Health Policy and Management and Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands.
authors.forename: Maureen P M H
authors.initials: MP
authors.lastname: Rutten-van Mölken
authors.affiliation: Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Frits
authors.affiliation: Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Christine K
authors.initials: CK
authors.lastname: Iannaccone
authors.affiliation: Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Shadick
authors.affiliation: Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Weinblatt
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D015415:Biomarkers / Q000097:blood; D001900:Boston; D002097:C-Reactive Protein / Q000032:analysis; D004185:Disability Evaluation; D005260:Female; D019983:Guideline Adherence; D006295:Health Resources / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011788:Quality of Life; D012042:Registries; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D018836:Inflammation Mediators; D002097:C-Reactive Protein