Does Treat-to-Target strategy compared to usual care reduce long-term structural joint damage in rheumatoid arthritis?

Moekotte, NL (2017) Does Treat-to-Target strategy compared to usual care reduce long-term structural joint damage in rheumatoid arthritis?

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Abstract:The aim of the study is to assess the relation between baseline variables and treatment strategy (Treat-to-Target strategy (T2T) or usual care) with disease activity and long-term outcome of structural joint damage of rheumatoid arthritis (RA). A second objective is to analyze whether practice variation results in clinically relevant differences in remission or in long-term outcome. This cohort study included 548 patients (usual care =267, T2T group=281) diagnosed with RA between 2006 and 2011 in a regional teaching hospital in the Netherlands. Disease activity was examined with disease activity scores (DAS28). Long-term outcome (Health Assessment Questionnaire (HAQ)) and structural joint damage (Rheumatoid Arthritis Articular Damage (RAAD)) was assessed after 5 – 10 years during routine outpatient visits. There are no major differences between the groups at baseline. T2T strategy is superior to usual care in achieving faster remission and better disease activity. Patients in remission are more likely to have better long-term outcome. Structural joint damage (RAAD-score) is not significantly more present in the usual care or T2T group, however more patients in the T2T group do have better functional ability (HAQ). Age and erosion at baseline are associated with structural joint damage. Rheumatologists have clinical differences of the DAS28 scores.
Item Type:Essay (Master)
Faculty:TNW: Science and Technology
Subject:44 medicine
Programme:Health Sciences MSc (66851)
Link to this item:http://purl.utwente.nl/essays/72930
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