title: Implementation of protocolized tight control and biological dose optimization in daily clinical practice: results of a pilot study.
abstract: OBJECTIVE
  To assess the effects of education, guideline development, and individualized treatment advice on rheumatologist adherence to tight control-based treatment and biological dose optimization in rheumatoid arthritis (RA), psoriatic arthritis (PsA), and spondyloarthropathy (SpA) patients.
  
  
  METHODS
  This pilot study, among two rheumatologists and two specialized nurses in a general hospital, combined education, feedback, local guideline development, and individualized treatment advice. Outcomes (baseline and 1 year post-intervention) were the percentage of patients with a Disease Activity Score in 28 joints (DAS28) or Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) measured during the visit, mean DAS28/BASDAI, and the percentage of patients using a reduced biological dose. DAS28 outcomes only applied to RA and PsA patients, BASDAI outcomes only applied to SpA patients whereas outcomes on biological dose applied to all patients.
  
  
  RESULTS
  A total of 232 patients (67% RA, 15% PsA, 18% SpA; 58% female, mean age 56 ± 15 years) were included in the study. The percentage of DAS28 and BASDAI measurements performed increased after the intervention [DAS28 15-51%, odds ratio (OR) 3.3, 95% confidence interval (CI) 2.1-5.5; BASDAI 23-50%, OR 2.2, 95% CI 1.0-5.5], with mean DAS28 and BASDAI scores remaining similar (DAS28: mean difference 0.1, 95% CI -0.3 to 0.5; BASDAI: mean difference 0.03, 95% CI -1.8 to 1.9). Use of a reduced biological dose increased from 10% to 61% (OR 3.9, 95% CI 2.4-6.5).
  
  
  CONCLUSIONS
  A multicomponent intervention strategy aimed at rheumatologists can lead to improved adherence to tight control-based treatment and a reduction in the use of biologicals in RA, SpA, and PsA patients.
authors.affiliation: a Department of Rheumatology , Sint Maartenskliniek , Nijmegen , The Netherlands.
authors.forename: N
authors.initials: N
authors.lastname: Lesuis
authors.affiliation: a Department of Rheumatology , Sint Maartenskliniek , Nijmegen , The Netherlands.
authors.forename: L M
authors.initials: LM
authors.lastname: Verhoef
authors.affiliation: a Department of Rheumatology , Sint Maartenskliniek , Nijmegen , The Netherlands.
authors.forename: L M
authors.initials: LM
authors.lastname: Nieboer
authors.affiliation: b Department of Rheumatology , MC Zuiderzee , Lelystad , The Netherlands.
authors.forename: G A
authors.initials: GA
authors.lastname: Bruyn
authors.affiliation: b Department of Rheumatology , MC Zuiderzee , Lelystad , The Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: Baudoin
authors.affiliation: c Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID) , Karolinska Institute , Stockholm , Sweden.
authors.forename: R F
authors.initials: RF
authors.lastname: van Vollenhoven
authors.affiliation: d IQ healthcare , Radboud Institute for Health Sciences, Radboud University Medical Centre , Nijmegen , The Netherlands.
authors.forename: Mejl
authors.initials: M
authors.lastname: Hulscher
authors.affiliation: a Department of Rheumatology , Sint Maartenskliniek , Nijmegen , The Netherlands.|e Department of Rheumatology , Radboud University Medical Centre , Nijmegen , The Netherlands.
authors.forename: Fhj
authors.initials: F
authors.lastname: van den Hoogen
authors.affiliation: a Department of Rheumatology , Sint Maartenskliniek , Nijmegen , The Netherlands.
authors.forename: A A
authors.initials: AA
authors.lastname: den Broeder
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D015535:Arthritis, Psoriatic / Q000188:drug therapy*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D002986:Clinical Trials as Topic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D025242:Spondylarthropathies / Q000188:drug therapy*
chemical_list: D018501:Antirheumatic Agents