SAT0724-HPR PROMISING OUTCOMES IN PATIENTS WITH RA UNDER A T2T PROGRAM AND A MULTIDISCIPLINARY DISEASE MANAGEMENT MODEL – 5 YEARS RESULTS FROM A RETROSPECTIVE COHORT
Authors: Anggie Aza, Michael Cabrera, Pedro Santos-Moreno, Laura Villarreal, Diana Buitrago-Garcia
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Rheumatoid arthritis (RA) is a common chronic inflammatory disease. It is characterized by progressive, irreversible joint damage, impaired joint function and pain, the disease causes disability and reduced quality of life. Treat-to-target (T2T) is a management strategy for RA. It proposes that the therapeutic goal in RA should be a state of remission, or an alternative goal could be a low disease activity, additionally it looks to achieve long-term health quality of life for the patients. Additionally, multiapproach programs for RA aim to take into account all components that interfere with the course of RA. <h3>Objectives:</h3> To describe the effectiveness of a T2T strategy associated to a disease management model with a multidisciplinary approach of patients with RA, according to disease activity measured with Activity Score 28 (DAS28) in a 5-year period in patients who receive conventional or biological DMARDs in a Colombian specialized in RA center. <h3>Methods:</h3> A descriptive cohort study was conducted. Medical records of patients from specialized in RA center were reviewed during 2015-2017; those patients were followed-up under T2T standards and a multidisciplinary approach. Clinical follow-up was designed by the authors according to DAS28 as follows: every 3-5 weeks (DAS28 &gt; 5.1), every 7-9 weeks (DAS28 ≥ 3.1 and ≤ 5.1), and every 11-13 weeks (DAS28 &lt; 3.1). Tender joint count (TJC), swollen joint count (SJC) and DAS28 were measured on each visit. Therapy had to be adjusted with DAS28 &gt; 3.2 unless patient´s conditions don't permit it; we considered this follow-up type as implementation of a T2T strategy in patients with RA. Patients entered into a multidisciplinary program of care with periodic consultations not only to rheumatology but with a physiatrist, psychologist, physiotherapist, occupational therapy nutrition, and, a patient focused program. With a multidisciplinary model of care the patient is seen as a whole, and the expectation is to achieve the best results in the management of RA. We divided patients in four groups: remission (REM), low disease activity (LDA), moderate disease activity (MDA) and high disease activity (HDA) patients and the aim of the study was to look at what percentage of patients who were in moderate or severe disease activity reached a low disease activity or remission. Descriptive epidemiology was done, we calculated means, and standard deviations for continuous variables and categorical variables were presented as rates. We compared disease activity at base line and at the end of follow-up. <h3>Results:</h3> We included 4000 patients, 83% were female and 17% male; median age was 60 years RIQ (50-67). Regarding pharmacological therapy 77% were receiving conventional DMARDs while 37% were receiving biological DMARDs. At beginning 55% were in MDA, 26% in LDA and 19% and during 5 years 82% of our patients achieved remission. See table 1. We performed a Wilcoxon test in order to compare the mean DAS28 at baseline and at the end showing statistical significance (P&lt;0.05) <h3>Conclusion:</h3> A T2T strategy associated with a multiapproach disease management model improves considerably disease activity in patients with RA. This evidence from a real-life setting that shows the advantages of treating RA patients with a multidisciplinary team under a T2T model with a low-cost treatment. It is important to explore other predictors that can improve disease activity. <h3>References</h3> <h3>Disclosure of Interests:</h3> Anggie Aza: None declared, Michael Cabrera: None declared, Pedro Santos-Moreno Grant/research support from: Dr Santos has received research grants from Janssen, Abbvie and UCB, Speakers bureau: Dr Santos has received speaker fees from Sanofi, Lilly, Bristol, Pfizer, Abbvie, Janssen and UCB, Laura Villarreal: None declared, Diana Buitrago-Garcia: None declared