Barriers to Optimal Disease Control for Rheumatoid Arthritis Patients With Moderate and High Disease Activity

• DOI: 10.1002/acr.22108
• Publication Date: 2013-08-27T20:40:46Z
• Authors: Kathleen Tymms; Jane Zochling; James Scott; Paul Bird; Simon Burnet; Julien de Jager; Hedley Griffiths; Dave Nicholls; Lynden Roberts; Mark Arnold; Geoffrey Littlejohn
• Keywords: Erythrocyte sedimentation rate; Demographics; Medical record; Disease Control

Objective To evaluate barriers that prevent rheumatoid arthritis (RA) patients from achieving Disease Activity Score in 28 joints using the erythrocyte sedimentation rate (DAS28‐ESR) scores within current recommended levels for low disease activity (LDA) or clinical remission (DAS28‐ESR score <3.2). Methods Using an electronic medical record program, data RA treated Optimising Patient Outcomes Australian Rheumatology clinics, with a recorded DAS28‐ESR score, were collected at one point time. The included demographics, medications, measures, and rheumatologist's opinion of main preventing improvement to DAS28 score. Results Of 4,037 304 (7.5%) had high (HDA) 1,211 (30%) moderate (MDA). For 584 HDA MDA patients, control (BTCs) by rheumatologist when there was no adjustment disease‐modifying antirheumatic drug (DMARD) therapy. BTCs irreversible joint damage (19.7%), patient‐driven preference (14.7%), noninflammatory musculoskeletal pain (9.2%), insufficient time assess effect recently initiated DMARDs safety concerns (7.5%), comorbidities (6.5%), resistant (6.3%), other less common reasons. These received (97.4%), including biologic agents (34.1%), methotrexate (74.8%), oral corticosteroids (41.8%). Conclusion This study identified situations which rheumatologists elected continue on DMARD therapy without achieve LDA target <3.2.