Rheumatologists’ adherence to a disease activity score steered treatment protocol in early arthritis patients is less if the target is remission
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- 作者：G. Akdemir ; I.M. Markusse ; Y.P.M. Goekoop-Ruiterman…
- 关键词：DAS steered protocols ; Early rheumatoid arthritis ; Physician ; Protocol adherence ; Treatment target
- 刊名：Clinical Rheumatology
- 出版年：2017
- 出版时间：February 2017
- 年：2017
- 卷：36
- 期：2
- 页码：317-326
- 全文大小：723KB
- 刊物类别：Medicine
- 刊物主题：Rheumatology;
- 出版者：Springer London
- ISSN：1434-9949
- 卷排序：36
文摘
To compare rheumatologists’ adherence to treatment protocols for rheumatoid arthritis (RA) targeted at Disease Activity Score (DAS) ≤2.4 or <1.6. The BeSt-study enrolled 508 early RA (1987) patients targeted at DAS ≤2.4. The IMPROVED-study included 479 early RA (2010) and 122 undifferentiated arthritis patients targeted at DAS <1.6. We evaluated rheumatologists’ adherence to the protocols and assessed associated opinions and conditions during 5 years. Protocol adherence was higher in BeSt than in IMPROVED (86 and 70 %), with a greater decrease in IMPROVED (from 100 to 48 %) than in BeSt (100 to 72 %). In BeSt, 50 % of non-adherence was against treatment intensification/restart, compared to 63 % in IMPROVED and 50 vs. 37 % were against tapering/discontinuation. In both studies, non-adherence was associated with physicians’ disagreement with DAS or with next treatment step and if patient’s visual analogue scale (VAS) for general health was ≥20 mm higher than the physician’s VAS. In IMPROVED, also discrepancies between swelling, pain, erythrocyte sedimentation rate, and VASgh were associated with non-adherence. Adherence to DAS steered treatment protocols was high but decreased over 5 years, more in a DAS <1.6 steered protocol. Non-adherence was more likely if physicians disagreed with DAS or next treatment step. In the DAS <1.6 steered protocol, non-adherence was also associated with discrepancies between subjective and (semi)objective disease outcomes, and often against required treatment intensification. These results may indicate that adherence to DAS-steered protocols appears to depend in part on the height of the target and on how physicians perceive the DAS reflects RA activity.