Analysis of data from Treat to Target (T2T) in early Rheumatoid Arthritis Patients – Interim results from Registered Advanced Nurse Practitioner (RANP) clinic
Harrington,N. McGowan,B. Whelan, B. Silke,C. Whelan,F.
North West Rheumatology Unit, Our Lady Hospital Manorhamilton
The 2010 European League Against Rheumatism (EULAR) recommend that rheumatoid arthritis (RA) patients should ultimately strive for remission with low disease activity (LDA) as an alternative goal within six months of diagnosis (2). The RANP with prescriptive authority can escalate or combine DMARD treatments as per agreed local protocol based on current guidelines from the European League against Rheumatism (1,2).
The aim was to develop, implement, and evaluate a treat-to-target strategy aimed at achieving remission in newly diagnosed RA in daily clinical practice.
From August 2014, following consultant diagnoses of RA, patients were referred to the RANP for 1 year follow up from diagnosis. Data on disease history, management & outcomes are collected at each visit. As per T2T recommendations 4-6 week assessment of disease activity was recorded using Clinical Disease Activity Index (CDAI) until low disease activity was achieved.
Fifty nine patients (61% female) following a consultant diagnosis of new onset RA and initiation of DMARD were referred to the T2T clinic. The mean follow time was 6 months (min 1 month, max 11 months). The mean age was 54yrs (SD 16, min 19, max 86). DMARD treatment adjustments were based on CDAI aiming at CDAI remission of <2.
Duration of symptoms before referral to rheumatologist were documented, 15 (25%) were referred within 3 months of symptom onset with 21(36%) referred within 3-6 months, 19% had symptoms > 1 year before referral. Following referral 32% were seen within 6 weeks of referral, 37% waited 6-12 weeks, 20% waited 3-6 months and 10% were seen within 6-12 months.
Mean baseline CDAI was 22 with SD 11 (min 2, maximum 67), 2 pts had baseline LDA and were on steroid treatment. A total of 26 (44%) of patients had been treated with steroids for symptoms prior to review. Target of disease remission was agreed with 53 (89.9%) of patients, target of LDA agreed with 6 (10.1%) of patients. 4 patients were excluded from analysis of remission data as diagnosis reclassified. To date 42 pts (76%) have achieved LDA. 46 (83%) of patients had >3month follow up with 23 (50%) of these achieving CDAI disease remission.
The implementation of this Nurse led treat-totarget strategy aiming at remission demonstrated that achieving remission in daily clinical practice is a realistic goal. This study is ongoing further results will be presented in due course.