title: Long-term outcomes of treat-to-target strategy in established rheumatoid arthritis: a daily practice prospective cohort study.
abstract: To examine disease activity and physical function after implementation of treat-to-target (T2T) strategy in patients with established rheumatoid arthritis (RA) over a long-term period. Patients with RA were started on a T2T strategy in 2005 and followed through 2014. Patients were seen every 3-4 months until remission/low disease activity was achieved and every 6 months thereafter. Disease activity was measured by the DAS28 and CDAI, and physical function by the HAQ-DI. Results were presented as all observed data, without imputation for missing values. Changes in disease activity and physical function were evaluated by generalized estimating equations (GEE). Two hundred and twenty-nine patients were included, with a mean (SD) disease duration of 10.6 (7.4) years. Significant improvements were seen in both composite scores during the follow-up period, as demonstrated by DAS28 (β coefficient = 0.19; 95% CI = 0.16-0.21; p < 0.01) and by CDAI (β coefficient = 1.59; 95% CI = 1.84-1.34; p < 0.01). Physical function also improved, as demonstrated by HAQ-DI (β coefficient = 0.03; 95% CI = 0.02-0.04; p < 0.01). Biological therapy was associated with improvement in disease activity and in physical function. Leflunomide was only associated with improvement in physical function. Clinically meaningful reductions of DAS28, CDAI and HAQ-DI were observed in patients with established rheumatoid arthritis from 2005 to 2014. Implementation of new therapeutic options, in the scenario of T2T strategy, was associated with improvement in disease activity and physical function.
authors.affiliation: Department of Internal Medicine, Federal University of Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2400, Porto Alegre, RS, 90035-002, Brazil. nandrade@hcpa.edu.br.|Rheumatology Division, Hospital de Clínicas (HCPA), Rua Ramiro Barcelos, 2350/645, Porto Alegre, RS, 90035-903, Brazil. nandrade@hcpa.edu.br.
authors.forename: Nicole Pamplona Bueno
authors.initials: NPB
authors.lastname: de Andrade
authors.affiliation: Department of Internal Medicine, Federal University of Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2400, Porto Alegre, RS, 90035-002, Brazil.|Rheumatology Division, Hospital de Clínicas (HCPA), Rua Ramiro Barcelos, 2350/645, Porto Alegre, RS, 90035-903, Brazil.
authors.forename: Rafael Mendonça
authors.initials: RM
authors.lastname: da Silva Chakr
authors.affiliation: Department of Internal Medicine, Federal University of Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2400, Porto Alegre, RS, 90035-002, Brazil.|Rheumatology Division, Hospital de Clínicas (HCPA), Rua Ramiro Barcelos, 2350/645, Porto Alegre, RS, 90035-903, Brazil.
authors.forename: Ricardo Machado
authors.initials: RM
authors.lastname: Xavier
authors.affiliation: Department of Internal Medicine, Federal University of Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2400, Porto Alegre, RS, 90035-002, Brazil.
authors.forename: Daniela
authors.initials: D
authors.lastname: Viecceli
authors.affiliation: Department of Internal Medicine, Federal University of Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2400, Porto Alegre, RS, 90035-002, Brazil.
authors.forename: Ricardo Henrique Bilycz
authors.initials: RHB
authors.lastname: Correa
authors.affiliation: Department of Internal Medicine, Federal University of Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2400, Porto Alegre, RS, 90035-002, Brazil.
authors.forename: Cilomar Martins
authors.initials: CM
authors.lastname: de Oliveira Filho
authors.affiliation: Department of Internal Medicine, Federal University of Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2400, Porto Alegre, RS, 90035-002, Brazil.|Rheumatology Division, Hospital de Clínicas (HCPA), Rua Ramiro Barcelos, 2350/645, Porto Alegre, RS, 90035-903, Brazil.
authors.forename: Claiton Viegas
authors.initials: CV
authors.lastname: Brenol
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000503:physiopathology; D001688:Biological Products / Q000627:therapeutic use*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020127:Recovery of Function; D012074:Remission Induction; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000276:immunology
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products; D014409:Tumor Necrosis Factor-alpha
keywords: Cohort study; Established rheumatoid arthritis; Rheumatoid arthritis; Treat-to-target