AB0691 IS TREAT TO TARGET HELPING US TO ACHIEVE OUR TARGETS IN RHEUMATOID ARTHRITIS? AUDIT COMPLETION FOR MONITORING THE IMPLEMENTATION OF TREAT-TO-TARGET IN ROUTINE CLINICAL PRACTICE IN A DISTRICT GENERAL HOSPITAL
Authors: R. S. Pearce, V. Morrish, A. J. Escudero Siosi, J. Mcnally
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Regular treatment adaptations during clinical assessments are essential to achieve remission in rheumatoid arthritis (RA). However, if this is not achievable, especially in longstanding disease, then low disease activity should be aimed for. This perspective constitutes the treat to Target (T2T) concept, initially developed by an international task force of Rheumatologists in 2010 and updated in 2014. We completed an audit cycle to measure the implementation of treat to target in our rheumatology clinic and the impact of additional recommendations from our previous departmental audit, which included prompt escalation of Methotrexate, documenting disease activity score (DAS28) regularly and the role of imaging to assess uncertain cases. <h3>Objectives:</h3> To determine the proportion of RA patients achieving remission by applying treat to target approach in the rheumatology clinic at Royal Berkshire hospital (RBH) in Reading, United Kingdom. <h3>Methods:</h3> We conducted a retrospective data analysis of 150 medical records of patients with RA, from January 2022 to January 2023. Patients were divided into Early Inflammatory Arthritis (EIA) clinic doctor led 3 and 12 months follow up, regular follow up on disease-modifying antirheumatic drugs (DMARDs) and on biologic treatment, 50 patients were selected from each group. Results were compared with published standards (T2T) and data from the initial audit conducted three years earlier. <h3>Results:</h3> Data showed that 69% of patients were female and a high proportion had seropositive RA 56%. Patient age ranged from 27-92 years with a mean of 61 years. DAS28 scores were calculated for 141 patients (94%). In the EIA group 36% achieved remission by 3 months compared to 28% in the previous audit showing a 29% improvement with regular escalation of treatment. By 1 year 50% had achieved remission in the same group. Average DAS28 at 3 months was 3.31 compared to 4.37 at baseline in the EIA group. Of the patients in DMARDs follow up group 46% were in remission (original audit 64%) and in the biologics group 44%, which was similar to the original audit. The proportion of EIA patients with low disease activity increased from 16% to 18%. Low disease activity was the same in both audits in the DMARDs group and was marginally lower in the biologics group; 21% versus 22% original audit. In both the EIA and DMARDs groups, the proportion of patients with either moderate or severe disease was lower, however the proportion was higher in the biologics group in the reaudit. Regarding treatment, 38 patients were on Methotrexate (MTX) at the 3 months doctor follow up, 12 were on another DMARD or MTX had been stopped prior to the appointment. We found that 20 patients (53%) had not had their treatment escalated from 15mg MTX. In the DMARD follow up group, 11 patients had active disease and were on 2 or more DMARDs, although 56% were started on biologics, 27% were not and 18% were sent for further radiological imaging. 18% of patients in both follow up groups had other factors contributing to their pain, predominantly osteoarthritis. Overall, 40 % remission rate was achieved. <h3>Conclusion:</h3> The implementation of treat to target and previous departmental audit recommendations have improved remission in the early inflammatory arthritis group. In contrast there has not been significant change among the other groups. Overall, there are more patients with moderate disease, suggesting we should review threshold for biologics. Additionally, a proportion of EIA patients are not having their treatment escalated, therefore we will be reviewing our EIA pathway to include a standardised escalation plan for the first 3 months. We will also be conducting a staff survey to explore the barriers to documenting DAS28 score and implementing T2T in clinic, to optimise the outcomes in patients with rheumatoid arthritis. <h3>REFERENCES:</h3> [1] Smolen JS. Treat-to-target as an approach in inflammatory arthritis. Curr Opin Rheumatol. 2016 May;28(3):297-302 [2] Smolen JS, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update. Ann Rheum Dis. 2023 Jan;82(1):3-18 <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>